Factors associated with the development of ocular candidiasis and ocular prognosis with echinocandin therapy for candidemia

Daiki Sakai,Makoto Nakamura,Wataru Matsumiya,Sentaro Kusuhara

doi:10.1186/s12348-021-00248-0

Daiki Sakai, Makoto Nakamura + Show 2 more

Open Access

https://doi.org/10.1186/s12348-021-00248-0

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Abstract

PurposeTo evaluate the factors associated with the development of ocular candidiasis (OC) and ocular prognosis with echinocandin therapy for candidemia.MethodsThe medical records of 56 consecutive patients with a positive blood culture for Candida species between November 2016 and October 2019 were retrospectively reviewed. Information on patient characteristics, isolated Candida species, treatment details for candidemia, and ocular findings were extracted to identify factors associated with OC development.ResultsThe leading pathogen of candidemia was Candida albicans (C.albicans) (41.1%). Of 56 patients, 18 (32.1%) were diagnosed with chorioretinitis, categorized as either probable (8 patients) or possible OC (10 patients). There was no case of endophthalmitis with vitritis. The incidence of probable OC was not significantly different between the groups treated with echinocandins and other antifungal drugs (15.2% vs. 11.1%, p = 1.00). In all probable OC cases, systemic antifungal therapy was switched from echinocandins to azoles, and no case progressed to endophthalmitis. A multivariate logistic analysis revealed that female sex (adjusted odds ratio [aOR], 8.93; 95% confidence interval [CI], 1.09–72.9) and C. albicans (aOR, 23.6; 95% CI, 1.8–281) were independent factors associated with the development of probable OC.ConclusionOne-seventh of patients with candidemia developed probable OC. Given the evidence of female and C. albicans as the factors associated with OC development, careful ophthalmologic management is required with these factors, especially in candidemia. Although echinocandins had no correlation with OC development and did not lead to the deterioration of ocular prognosis, further investigation is required.

Highlights

Without early diagnosis and appropriate treatment, candidemia is a potentially fatal bloodstream infection worldwide [1]
The ratio of C. albicans as the responsible species for candidemia has decreased
In the present study with eight probable ocular candidiasis (OC) cases of 56 candidemia cases, we showed that the presence of C. albicans and being female were significant factors associated with OC development

Summary

Introduction

Without early diagnosis and appropriate treatment, candidemia is a potentially fatal bloodstream infection worldwide [1]. There have been recent trends in increasing echinocandin use [5] and prompt initiation of antifungal therapy [6]. Echinocandins have emerged as preferred agents for most episodes of candidemia and invasive candidiasis, except for the involvement of the central nervous system, eye, and urinary tract, where they can achieve poor concentration. This preference is based on a strong safety profile, convenience, early fungicidal activity, and a trend toward better outcomes based on data from individual studies and combined analyses of candidemia studies [8, 9]

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