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Title: The incidence of endophthalmitis or macular involvement and the necessity of a routine ophthalmic examination in patients with candidemia
Authors: Ueda, Takashi
Takesue, Yoshio
Tokimatsu, Issei
Miyazaki, Taiga
Nakada-Motokawa, Nana
Nagao, Miki
Nakajima, Kazuhiko
Mikamo, Hiroshige
Yamagishi, Yuka
Kasahara, Kei
Yoshihara, Shingo
Ukimura, Akira
Yoshida, Koichiro
Yoshinaga, Naomi
Izumi, Masaaki
Kakeya, Hiroshi
Yamada, Koichi
Kawamura, Hideki
Endou, Kazuo
Yamanaka, Kazuaki
Yoshioka, Mutsunobu
Amino, Kayoko
Ikeuchi, Hiroki
Uchino, Motoi
Miyazaki, Yoshitsugu
Author's alias: 長尾, 美紀
Issue Date: 23-May-2019
Publisher: Public Library of Science (PLoS)
Journal title: PloS one
Volume: 14
Issue: 5
Thesis number: e0216956
Abstract: 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.
Rights: © 2019 Ueda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
DOI(Published Version): 10.1371/journal.pone.0216956
PubMed ID: 31120928
Appears in Collections:Journal Articles

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