Endogenous fungal endophthalmitis is being increasingly recognized in susceptible individuals. We report a case of endogenous endophthalmitis due to Fusarium solani that occurred as the sole clinical manifestation of fungal disease in an immunocompromised host. Four previously reported cases of endogenous fusarial endophthalmitis are also reviewed. Two of these patients had no underlying disease and presented with isolated endophthalmitis, while two other patients had acute leukemia and presented with multiple organ involvement due to Fusarium. All three patients with leukemia, including our patient, were severely neutropenic at the time of diagnosis. Two of these three patients had fungemia. MICs of amphotericin B for fungal isolates ranged from 0.14 to 10 micrograms/mL. Despite abatement of the endophthalmitis after antifungal therapy and vitrectomy, the prognosis for immunocompromised patients remains guarded because of underlying disease.

Objective Limited data are available to guide effective antibiotic durations for hospitalized patients with complicated urinary tract infections (cUTI). Methods We conducted an observational study of patients ≥18 years at 24 United States hospitals to identify the optimal treatment duration for patients with cUTI. To increase the likelihood patients experienced true infection, eligibility was limited to those with associated bacteremia. Propensity scores were generated for an inverse probability of treatment weighted analysis. The primary outcome was recurrent infection with the same species within 30 days of completing therapy. Results 1,099 patients met eligibility criteria and received 7, 10, or 14 days of therapy. There was no difference in the odds of recurrent infection for 382 (46%) patients receiving 10 days and 452 (54%) patients receiving 14 days of therapy (aOR 0.99, 95% CI, 0.52-1.87). An increased odds of recurrence was observed in 265 (37%) patients receiving 7 days versus 452 (63%) patients receiving 14 days of treatment (aOR 2.54, 95% CI, 1.40-4.60). When limiting the 7-day versus 14-day analysis to the 627 patients who remained on intravenous beta-lactam therapy or were transitioned to highly bioavailable oral agents, differences in outcomes no longer persisted; aOR 0.76, 95% CI, 0.38-1.52. Of 76 patients with recurrent infections, 2 (11%), 2 (10%), and 10 (36%) in the 7, 10, and 14-day groups, respectively, had drug-resistant infections (p=0.10). Conclusion Seven days of antibiotics appears effective for hospitalized patients with cUTI when antibiotics with comparable IV and oral bioavailability are administered; 10 days may be needed for all other patients.

Intravesical instillation of Bacillus Calmette-Guerin (BCG) is a treatment to prevent recurrence of superficial urothelial bladder carcinoma. Complications after bladder instillation of BCG have been reported including locally invasive and systemic infections due to dissemination of Mycobacterium bovis from the bladder. We present an uncommon case and literature review of prosthetic joint infection due to M. bovis after intravesical BCG treatment of bladder cancer.

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