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

BACKGROUND

The 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.

METHODS

This 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.

RESULTS

In 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.

CONCLUSION

Even 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.

Déclaration de conflit d'intérêts

Y. Takesue has received grant support from Sumitomo Dainippon Pharma Co., Ltd., and Shionogi & Co., Ltd., and payment for lectures from Astellas Pharma Inc., and MSD Japan. T Miyazaki has received research grants from Astellas Pharma Inc., Pfizer Japan Inc., MSD Japan, and Asahi Kasei Pharma Co. H. Mikamo has received grant support from Sumitomo Dainippon Pharma Co., Ltd., Astellas Pharma Inc., Pfizer Japan Inc., MSD Japan, and payment for lectures from MSD Japan, Astellas Pharma Inc., and Sumitomo Dainippon Pharma Co., Ltd. Y. Yamagishi has received grant support from Pfizer Japan Inc., MSD Japan, Astellas Pharma Inc., and Sumitomo Dainippon Pharma Co., Ltd., and payment for lectures from Sumitomo Dainippon Pharma Co., Ltd., and MSD Japan. K. Yoshida has received payment for lectures from MSD Japan, Pfizer Japan Inc., and Sumitomo Dainippon Pharma Co., Ltd. H. Kakeya has received grant support from Pfizer Japan Inc., MSD Japan, Astellas Pharma Inc., and Sumitomo Dainippon Pharma Co., Ltd. Other authors have no conflict of interest to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.