1173. Ocular Candidiasis in Patients with Candidemia Diagnosed by Blood Culture Versus T2Candida® Assay

Abstract

Background Ocular candidiasis (OC) is a serious complication of candidemia. Current guidelines recommend dilated fundoscopic exam (DFE) in all patients with candidemia. In this study, we examined characteristics and outcomes of patients at UAB Medical Center with candidemia diagnosed by blood culture (BC) or T2Candida® rapid diagnostic assay (T2C) who were found to have evidence of fungal disease on ophthalmologic exam. Methods Patients from 2016-2019 with either 1) at least one positive BC for Candida species or 2) positive T2C assay and negative or no paired BC were identified and retrospectively reviewed. Patients with additional positive BC or T2C within 60 days were excluded from the analysis. Data collected included risk factors for candidemia, causative Candida species, and whether DFE was performed after diagnosis. Patients with evidence of OC by exam were compared by type of ocular involvement (chorioretinitis vs. vitritis), whether visual symptoms were present, and whether intravitreal injection was performed. Results A total of 360 episodes of candidemia diagnosed by BC and 288 by T2C alone were included. Of those who underwent DFE, 33 BC patients (12.9%) had findings concerning for OC compared to 18 (8.9%) T2C patients (p=0.177) (Table 2). T2C patients with OC were younger, were more likely to have a prolonged ICU stay and to be mechanically ventilated, and were less likely to be on TPN compared to the BC group. Identification of C. parapsilosis was significantly more common in T2C patients (Table 1). There were no significant differences in presence of visual symptoms, type of ocular involvement, need for intravitreal injection, or 30-day mortality (Table 3). Table 1. Demographics and risk factors Table 2. Episodes of candidemia and ocular candidiasis by year Table 3. Ocular findings and outcomes Conclusion The frequency of ocular disease was similar between groups. Significantly more T2C patients had candidemia due to C. parapsilosis, and the groups differed in terms of risk factors for candidemia. There were no differences in frequency of intravitreal injection, severity of eye disease, or mortality. Despite recent concerns about the necessity of DFE in asymptomatic patients with candidemia, we believe these results emphasize the importance of performing DFE in candidemic patients and also support the practice of doing so in patients with positive T2C even in the absence of positive blood cultures. Disclosures Peter Pappas, MD, SCYNEXIS, Inc. (Consultant, Advisor or Review Panel member, Research Grant or Support) Todd P. McCarty, MD, Amplyx (Scientific Research Study Investigator)Cidara (Scientific Research Study Investigator)

T2Candida for the Diagnosis and Management of Invasive Candida Infections

“…Of those who underwent dilated fundoscopic examination, ocular candidiasis was present in 13% in the blood culture group and 9% in the T2Candida positive group (p = 0.177) [41]. Identification of C. parapsilosis was significantly more common in the T2Candida patients, however, there were no differences in presence of visual symptoms, type of ocular involvement, need for intravitreal injection, or mortality [41]. These early studies suggest a potential adjunctive role of T2Candida in the diagnosis and early treatment of ocular candidiasis especially in the setting of negative blood cultures.…”

“…Given that fungal PD fluid cultures typically take 24-48 h to turn positive, the rapid turnaround time of T2MR may represent an opportunity to initiate early targeted antifungals and discontinue unnecessary intraperitoneal antibiotics. Two published abstracts have investigated T2Candida in the setting of ocular candidiasis, a potential sight-threatening condition that may require modification of systemic antifungal therapy or the intravitreal instillation of antifungals [40,41]. A retrospective evaluation was performed of 164 patients that had inpatient ophthalmology consultation for suspected ocular candidiasis at a Detroit academic hospital [40].…”

“…Sensitivity of T2Candida was 75% for those with definite chorioretinitis as compared to 64% for blood cultures [40]. Another study reviewed 360 episodes of blood culture proven candidemia and 288 episodes of T2Candida positive alone (without positive blood cultures) over the course of 4 years at an Alabama health system [41]. Of those who underwent dilated fundoscopic examination, ocular candidiasis was present in 13% in the blood culture group and 9% in the T2Candida positive group (p = 0.177) [41].…”

“…Another study reviewed 360 episodes of blood culture proven candidemia and 288 episodes of T2Candida positive alone (without positive blood cultures) over the course of 4 years at an Alabama health system [41]. Of those who underwent dilated fundoscopic examination, ocular candidiasis was present in 13% in the blood culture group and 9% in the T2Candida positive group (p = 0.177) [41]. Identification of C. parapsilosis was significantly more common in the T2Candida patients, however, there were no differences in presence of visual symptoms, type of ocular involvement, need for intravitreal injection, or mortality [41].…”