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

Takashi Ueda¹, Yoshio Takesue¹, Issei Tokimatsu^{2

3}, Taiga Miyazaki⁴, Nana Nakada-Motokawa⁴, Miki Nagao⁵, Kazuhiko Nakajima¹, Hiroshige Mikamo⁶, Yuka Yamagishi⁶, Kei Kasahara⁷, Shingo Yoshihara⁷, Akira Ukimura⁸, Koichiro Yoshida⁹, Naomi Yoshinaga⁹, Masaaki Izumi¹⁰, Hiroshi Kakeya¹¹, Koichi Yamada¹¹, Hideki Kawamura¹², Kazuo Endou¹³, Kazuaki Yamanaka¹⁴, Mutsunobu Yoshioka¹⁵, Kayoko Amino¹⁶, Hiroki Ikeuchi¹⁷, Motoi Uchino¹⁷, Yoshitsugu Miyazaki¹⁸

Affiliations

¹ Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan.
² Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan.
³ Department of Infection Prevention and Control, Kobe University Hospital, Kobe, Japan.
⁴ Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan.
⁵ Department of Infection Control and Prevention, Kyoto University Hospital, Kyoto, Japan.
⁶ Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan.
⁷ Center for Infectious Diseases, Nara Medical University, Nara, Japan.
⁸ Infection Control Center, Osaka Medical College Hospital, Osaka, Japan.
⁹ Kindai University Hospital, Osaka, Japan.
¹⁰ Department of Internal Medicine, Kansai Rosai Hospital, Amagasaki, Japan.
¹¹ Department of Infection Control Science, Graduate School of Medicine, Osaka City University, Osaka, Japan.
¹² Department of Infection Control and Prevention, Division of Medical and Environmental Safety, Kagoshima University Hospital, Kagoshima, Japan.
¹³ Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.
¹⁴ Department of Urology, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan.
¹⁵ Department of Pharmacy, Takarazuka City Hospital, Takarazuka, Japan.
¹⁶ Dentistry and Oral and Maxillofacial Surgery, Nishinomiya Central Municipal Hospital, Nishinomiya, Japan.
¹⁷ Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Japan.
¹⁸ Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo, Japan.

PMID: 31120928
PMCID: PMC6532890
DOI: 10.1371/journal.pone.0216956

Multicenter Study

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

Takashi Ueda et al. PLoS One. 2019.

. 2019 May 23;14(5):e0216956.

doi: 10.1371/journal.pone.0216956. eCollection 2019.

Authors

Affiliations

¹ Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan.
² Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan.
³ Department of Infection Prevention and Control, Kobe University Hospital, Kobe, Japan.
⁴ Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan.
⁵ Department of Infection Control and Prevention, Kyoto University Hospital, Kyoto, Japan.
⁶ Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan.
⁷ Center for Infectious Diseases, Nara Medical University, Nara, Japan.
⁸ Infection Control Center, Osaka Medical College Hospital, Osaka, Japan.
⁹ Kindai University Hospital, Osaka, Japan.
¹⁰ Department of Internal Medicine, Kansai Rosai Hospital, Amagasaki, Japan.
¹¹ Department of Infection Control Science, Graduate School of Medicine, Osaka City University, Osaka, Japan.
¹² Department of Infection Control and Prevention, Division of Medical and Environmental Safety, Kagoshima University Hospital, Kagoshima, Japan.
¹³ Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.
¹⁴ Department of Urology, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan.
¹⁵ Department of Pharmacy, Takarazuka City Hospital, Takarazuka, Japan.
¹⁶ Dentistry and Oral and Maxillofacial Surgery, Nishinomiya Central Municipal Hospital, Nishinomiya, Japan.
¹⁷ Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Japan.
¹⁸ Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo, Japan.

PMID: 31120928
PMCID: PMC6532890
DOI: 10.1371/journal.pone.0216956

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.

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Conflict of interest statement

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.

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources