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Infection

, Volume 46, Issue 5, pp 635–640 | Cite as

Prevalence of, and risk factors for, hematogenous fungal endophthalmitis in patients with Candida bloodstream infection

  • Hideaki Kato
  • Yukihiro Yoshimura
  • Yoshihiro Suido
  • Kazuo Ide
  • Yoshifumi Sugiyama
  • Kasumi Matsuno
  • Hideaki Nakajima
Original Paper

Abstract

Purpose

Endogenous fungal endophthalmitis (EFE) is a severe consequence of candidemia. The prevalence of, and risk factors for, EFE is not well studied.

Methods

We retrospectively collected cases of patients with candidemia who had undergone ophthalmological examination between April 2011 and March 2016 in five regional hospitals. We conducted bivariate and multivariate analyses using patients’ age, gender, causative Candida species, diabetes status, corticosteroid use, cancer status, neutropenia, intensive care unit admission, presence of central venous catheter (CVC), presence of shock, prior antibiotic use, 30-day mortality, and highest Sequential Organ Failure Assessment (SOFA) score. Data on sustained positive blood culture, β-d glucan, CVC removal, empirical antifungal drug used, and time to appropriate antifungal therapy were also collected if available.

Results

Of 174 patients with candidemia, 35 (20.1%) were diagnosed with EFE, including 31 (17.8%) with chorioretinitis and 4 (2.3%) with vitritis. Bivariate analysis (EFE group vs. non-EFE group) found that Candida albicans candidemia (77.1 vs. 34.5%, P < 0.001), neutropenia (14.3 vs. 5.8%, P = 0.141), CVC placement (94.3 vs. 71.2%, P = 0.004), and the presence of shock (28.6 vs. 16.5%, P = 0.145) were each higher in the EFE group. Multivariate logistic regression analysis found C. albicans candidemia (adjusted odds ratio 6.48; [95% CI 2.63–15.95]) and CVC placement (7.55 [1.56–36.53]) to be significant risk factors for EFE.

Conclusions

Candida albicans is the most common causative agent for Candida EFE. Patients with candidemia and CVC placement should be closely monitored by ophthalmologists.

Keywords

Bloodstream infection Candida Candidemia Endophthalmitis 

Notes

Acknowledgements

Hideaki Kato received grants from Shionogi and Company, Limited. Other co-authors have no conflict of interest to declare.

Compliance with ethical standards

Ethical standards

This study was approved by the ethics committee at each participating institution.

Conflict of interest

Hideaki Kato received grants from Shionogi and Company, Limited. Other co-authors have no conflict of interest to declare.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Hematology and Clinical ImmunologyYokohama City University School of MedicineYokohamaJapan
  2. 2.Department of Infectious DiseasesYokohama Municipal Citizen’s HospitalYokohamaJapan
  3. 3.Department of Respiratory MedicineFujisawa City HospitalFujisawaJapan
  4. 4.Infection Control TeamNational Hospital Organization Yokohama Medical CenterYokohamaJapan
  5. 5.Clinical Laboratory DepartmentYokohama City University Medical CenterYokohamaJapan
  6. 6.Department of Clinical LaboratoryYokohama Municipal Citizen’s HospitalYokohamaJapan

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