A Prospective Search for Ocular Lesions in Hospitalized Patients with Significant Bacteremia

Abstract

The purpose of this study was to determine the prevalence, risk factors, and prognostic value of ocular lesions in unselected patients with bacteremia. A total of 202 bacteremic patients, 101 nonbacteremic septic patients, and 90 nonseptic control patients were compared in a prospective, controlled, observational study. Ocular lesions related to bacteremia were found in 12% of the bacteremic group, 5% of the septic group, and 2% of the control group. Ocular lesions were significantly more frequent in the bacteremic patients than in the control patients (P=.007). The severity of the clinical condition and the presence of fungemia predict independently a higher risk of ocular lesions. Mortality rates among bacteremic patients with and without ocular lesions were, respectively, 32% and 8% (P<.01; OR, 3.99). The asymptomatic nature of most ocular lesions in patients with bloodstream infections and the impossibility of amelioration in most cases lead us to recommend ophthalmologic examination for bacteremic patients only when prognostic information is needed.

Invasive candidiasis in pediatric intensive care units

“…49 Endophthalmitis is the most common manifestation of eye involvement in candidemia. A recent study found ocular Candida chorioretinitis in 26% of the 31 patients with invasive candidiasis.…”

Risk Factors Predictive of Endogenous Endophthalmitis Among Hospitalized Patients With Hematogenous Infections in the United States

“…1 The leading cause of bacterial endogenous endophthalmitis is grampositive species in western countries (gram-negative species in Asian countries), and the leading cause of fungal endogenous endophthalmitis is Candida (followed by aspergillosis). [2][3][4][5][6] Endogenous endophthalmitis associated with hematogenous infections has been recognized for over a century, 7 more commonly among patients with fungemia than bacteremia, 8,9 but with wide variation in reported incidence rates-ranging from 12% to 26% incidence of retinal lesions in bacteremic patients [10][11][12] and from 0 to 78% incidence of chorioretinitis or endophthalmitis in patients with candidemia [13][14][15][16][17][18] -in studies with tens to hundreds of patients with hematogenous infections. 6 Clinical signs include infiltrative chorioretinitis and overlying vitritis (classic for candida endophthalmitis, though uncommon), as well as nonspecific findings such as cotton-wool spots, retinal hemorrhages, and whitecentered Roth spot hemorrhages.…”

The prevalence of bacteraemia-related retinal lesions in seriously ill patients

“…We have found only four studies in the English literature describing ocular involvement in bacteraemic patients. [5][6][7][8] Retinal lesions can be categorized according to disseminated bacterial infections and disseminated candidiasis:…”

“…Other retinal findings, such as macular degeneration, hyper-or hypopigmented spots and scars, were recorded but not considered to be related to bacteraemia and sepsis. 7,8 After these evaluations, patients were assigned to six groups: I. Bacteraemic non-septic: a patient was considered to have bacteraemia if he/she had a clinical infection and a positive blood culture but no clinical findings of sepsis. Bacteraemia was considered significant if at least one blood culture was positive, yielding either bacteria or fungi.…”

“…Septicaemia should be considered in the differential diagnosis of cotton-wool spots, haemorrhages or white-centered haemorrhages (Roth's spots) in the retina. [5][6][7][8] This study was designed to evaluate the prevalence of retinal lesions in different groups of critically ill patients. In addition, we tried to evaluate the risk factors for retinal involvement in patients with retinal lesions.…”