The incidence of endophthalmitis or macular involvement and the necessity of a routine ophthalmic examination in patients with candidemia.

Takashi Ueda,Kayoko Amino,Kazuhiko Nakajima,Nana Nakada-Motokawa,Taiga Miyazaki,Koichi Yamada,Hiroshige Mikamo,Miki Nagao,Hideki Kawamura,Kei Kasahara,Kazuo Endou,Yoshitsugu Miyazaki,Hiroshi Kakeya,Hiroki Ikeuchi,Issei Tokimatsu,Yoshio Takesue,Akira Ukimura,Yuka Yamagishi,Koichiro Yoshida,Motoi Uchino,Naomi Yoshinaga,Mutsunobu Yoshioka,Shingo Yoshihara,Masayuki Izumi ,Koji Yamanaka

doi:10.1371/journal.pone.0216956

Abstract

BackgroundThe incidence of ocular candidiasis (OC) in patients with candidemia varies across different reports, and the issue of whether routine ophthalmoscopy improves outcomes has been raised. This study investigated the incidence of OC and evaluate whether the extent of OC impacts the clinical outcomes.MethodsThis retrospective study included non-neutropenic patients with candidemia who underwent treatment at one of 15 medical centers between 2010 and 2016. Chorioretinitis without other possible causes for the ocular lesions and endophthalmitis was classified as a probable OC. If signs of chorioretinitis were observed in patients with a systemic disease that causes similar ocular lesions, they were classified as a possible OC.ResultsIn total, 781 of 1089 patients with candidemia underwent an ophthalmic examination. The prevalence of OC was 19.5%. The time from the collection of a positive blood culture to the initial ophthalmic examination was 5.0 ± 3.9 days in patients with OC. The leading isolate was Candida albicans (77.9%). Possible OC was associated with unsuccessful treatments (resolution of ocular findings) (odds ratio: 0.354, 95% confidence interval: 0.141–0.887), indicating an overdiagnosis in patients with a possible OC. If these patients were excluded, the incidence fell to 12.8%. Endophthalmitis and/or macular involvement, both of which require aggressive therapy, were detected in 43.1% of patients; a significantly higher incidence of visual symptoms was observed in these patients.ConclusionEven when early routine ophthalmic examinations were performed, a high incidence of advanced ocular lesions was observed. These results suggest that routine ophthalmic examinations are still warranted in patients with candidemia.

Highlights

Candida species are the fourth most common nosocomial bloodstream organism [1], and ocular involvement is reported as one of the main complications in patients with candidemia [2,3]
Possible ocular candidiasis (OC) was associated with unsuccessful treatments, indicating an overdiagnosis in patients with a possible OC
Endophthalmitis and/or macular involvement, both of which require aggressive therapy, were detected in 43.1% of patients; a significantly higher incidence of visual symptoms was observed in these patients

Summary

Introduction

Candida species are the fourth most common nosocomial bloodstream organism [1], and ocular involvement is reported as one of the main complications in patients with candidemia [2,3]. Oude Lashof et al [4] reported that 16% of patients with candidemia had ocular candidiasis (OC). Nagao et al [5] reported that 26.5% of patients with candidemia had findings consistent with those of OC. Krishna et al [6] reported that the overall incidence of OC was 26% in their study. Based on the considerably high incidence of OC in patients with candidemia, current guidelines [2, 3] recommended an ophthalmological examination for all patients with candidemia. Lower rates of OC ranging from 2.9% to. Data Availability Statement: All relevant data are within the manuscript and Supporting Information files

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