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

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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.

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References

  1. Durand ML. Endophthalmitis. Clin Microbiol Infect. 2013;19:227–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Krishna R, Amuh D, Lowder C, Gordon S, Adal K, Hall G. Should all patients with candidaemia have an ophthalmic examination to rule out ocular candidiasis? Eye. 2000;14:30–4.

    Article  PubMed  Google Scholar 

  3. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2015;62:e1–50.

    PubMed  PubMed Central  Google Scholar 

  4. Donahue S, Greven C, Zuravleff J, Eller A, Nguyen M, Peacock J, et al. Intraocular candidiasis in patients with candidemia. Clinical implications derived from a prospective multicenter study. Ophthalmology. 1994;101:1302–9.

    Article  CAS  PubMed  Google Scholar 

  5. Henderson DK, Edwards JE, Montgomerie JZ. Hematogenous Candida endophthalmitis in patients receiving parenteral hyperalimentation fluids. J Infect Dis. 2014;143:655–61.

    Article  Google Scholar 

  6. Brooks RG. Prospective study of Candida endophthalmitis in hospitalized patients with candidemia. Arch Intern Med. 1989;149:2226–8.

    Article  CAS  PubMed  Google Scholar 

  7. Geraymovych E, Conduff JH, Braich PS, Leffler CT, Brar VS. Prevalence and factors predictive of intraocular fungal infection in patients with fungemia at an academic urban tertiary care center. Clin Ophthalmol. 2015;9:1853–8.

    PubMed  PubMed Central  Google Scholar 

  8. Parke D, Jones D, Gentry L. Endogenous endophthalmitis among patients with candidemia. Ophthalmology. 1982;89:789–96.

    Article  PubMed  Google Scholar 

  9. Kannangara S, Shindler D, Kunimoto DY, Sell B, DeSimone JA. Candidemia complicated by endophthalmitis: a prospective analysis. Eur J Clin Microbiol Infect Dis. 2007;26:839–41.

    Article  CAS  PubMed  Google Scholar 

  10. Rodríguez-adrián LJ, King RT, Tamayo-derat LG, Miller JW, Garcia CA, Rex JH. Retinal lesions as clues to disseminated bacterial and candidal infections frequency, natural history, and etiology. Medicine (Baltimore). 2003;82:187–202.

    Google Scholar 

  11. Oude Lashof AML, Rothova A, Sobel JD, Ruhnke M, Pappas PG, Viscoli C, et al. Ocular manifestations of candidemia. Clin Infect Dis. 2011;53:262–8.

    Article  PubMed  Google Scholar 

  12. Chen KJ, Wu WC, Sun MH, Lai CC, Chao AN. Endogenous fungal endophthalmitis: Causative organisms, management strategies, and visual acuity outcomes. Am J Ophthalmol. 2012;154:213–4.

    Article  PubMed  Google Scholar 

  13. Diekema DJ, Messer SA, Brueggemann AB, Coffman SL, Doern GV, Herwaldt LA, et al. Epidemiology of candidemia: 3-year results from the emerging infections and the epidemiology of Iowa organisms study. J Clin Microbiol. 2002;40:1298–302.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. McDonnell P, McDonnell J, Brown R, Green W. Ocular involvement in patients with fungal infections. Ophthalmology. 1985;92:706–9.

    Article  CAS  PubMed  Google Scholar 

  15. Schelenz S, Gransden WR. Candidaemia in a London teaching hospital: analysis of 128 cases over a 7-year period. Mycoses. 2003;46:390–6.

    Article  CAS  PubMed  Google Scholar 

  16. Menezes A, Sigesmund DA, Demajo WA, Devenyi R. Mortality of hospitalized patients with Candida endophthalmitis. Arch Intern Med. 1994;154:2093–7.

    Article  CAS  PubMed  Google Scholar 

  17. Stephen BY, Feman S, Nichols JC, Invitation BY, Chung SM, Invitation BY, et al. Endophthalmitis in patients with disseminated fungal disease. Trans Am Ophthalmol Soc. 2002;100:67–72.

    Google Scholar 

  18. Binder B, Chua J, Kaiser P, Procop G, Isada C. Endogenous endophthalmitis: an 18-year review of culture-positive cases at a tertiary care center. Medicine (Baltimore). 2003;82:97–105.

    Article  Google Scholar 

  19. Raad I, Hanna H, Boktour M, Girgawy E, Danawi H, Mardani M, et al. Management of central venous catheters in patients with cancer and candidemia. Clin Infect Dis. 2004;38:1119–27.

    Article  PubMed  Google Scholar 

  20. Nucci M, Anaissie E, Betts RF, Dupont BF, Wu C, Buell DN, et al. Early removal of central venous catheter in patients with candidemia does not improve outcome: analysis of 842 patients from 2 randomized clinical trials. Clin Infect Dis. 2010;51:295–303.

    Article  PubMed  Google Scholar 

  21. Farmakiotis D, Kyvernitakis A, Tarrand JJ, Kontoyiannis DP. Early initiation of appropriate treatment is associated with increased survival in cancer patients with Candida glabrata fungaemia: a potential benefit from infectious disease consultation. Clin Microbiol Infect. 2015;21:79–86.

    Article  PubMed  Google Scholar 

  22. Morrell M, Fraser VJ, Kollef MH. Delaying the empiric treatment of Candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality delaying the empiric treatment of Candida bloodstream infection until positive blood culture. Antimicrob Agents Chemother. 2005;49:3640–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Zilberberg MD, Kollef MH, Arnold H, Labelle A, Micek ST, Kothari S, et al. Inappropriate empiric antifungal therapy for candidemia in the ICU and hospital resource utilization: a retrospective cohort study. BMC Infect Dis. 2010;10:150.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Mochizuki K, Sawada A, Suemori S, Kawakami H, Niwa Y, Kondo Y, et al. Intraocular penetration of intravenous micafungin in inflamed human eyes. Antimicrob Agents Chemother. 2013;57:4027–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Riddell IVJ, Comer GM, Kauffman CA. Treatment of endogenous fungal endophthalmitis: focus on new antifungal agents. Clin Infect Dis. 2011;52:648–53.

    Article  CAS  PubMed  Google Scholar 

  26. Hariprasad SM, Mieler WF, Holz ER, Gao H, Kim JE, Chi J, et al. Determination of vitreous, aqueous, and plasma concentration of orally administered voriconazole in humans. Arch Ophthalmol. 2004;122:42–7.

    Article  CAS  PubMed  Google Scholar 

  27. Blennow O, Tallstedt L, Hedquist B, Gårdlund B. Duration of treatment for candidemia and risk for late-onset ocular candidiasis. Infection. 2013;41:129–34.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

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

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Authors and Affiliations

  1. Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Hideaki Kato & Hideaki Nakajima

  2. Department of Infectious Diseases, Yokohama Municipal Citizen’s Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-8555, Japan

    Yukihiro Yoshimura

  3. Department of Respiratory Medicine, Fujisawa City Hospital, 2-6-1 Fujisawa, Fujisawa, 251-0052, Japan

    Yoshihiro Suido

  4. Infection Control Team, National Hospital Organization Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-ku, Yokohama, 245-8575, Japan

    Kazuo Ide

  5. Clinical Laboratory Department, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan

    Yoshifumi Sugiyama

  6. Department of Clinical Laboratory, Yokohama Municipal Citizen’s Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-8555, Japan

    Kasumi Matsuno

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  1. Hideaki Kato
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  2. Yukihiro Yoshimura
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  7. Hideaki Nakajima
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Correspondence to Hideaki Kato.

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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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Kato, H., Yoshimura, Y., Suido, Y. et al. Prevalence of, and risk factors for, hematogenous fungal endophthalmitis in patients with Candida bloodstream infection. Infection 46, 635–640 (2018). https://doi.org/10.1007/s15010-018-1163-z

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  • DOI: https://doi.org/10.1007/s15010-018-1163-z

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