Do all candidemic patients need an ophthalmic examination?

Vinikoor, Michael J.; Zoghby, Jonathan; Cohen, Kenneth L.; Tucker, Joseph D.

doi:10.1016/j.ijid.2012.12.014

Cited by 32 publications

(25 citation statements)

References 20 publications

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“…Performance of the examination resulted in a change in antifungal therapy in only 5.6% of the 168 patients. On the contrary, ophthalmoscopy generates an increase in hospital costs ($400 per consultation), is uncomfortable for patients, and carries a small risk of acute angle-closure glaucoma [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Is routine ophthalmoscopy really necessary in candidemic patients?

et al. 2017

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The purpose of this study was to determine among patients with candidemia the real rate of ophthalmoscopy and the impact of performing ocular assessment on the outcome of the disease. We performed a post hoc analysis of a prospective, multicenter, population-based candidemia surveillance program implemented in Spain during 2010–2011 (CANDIPOP). Ophthalmoscopy was performed in only 168 of the 365 patients with candidemia (46%). Ocular lesions related to candidemia were found in only 13/168 patients (7.7%), of whom 1 reported ocular symptoms (incidence of symptomatic disease in the whole population, 0.27% [1/365]). Ophthalmological findings led to a change in antifungal therapy in only 5.9% of cases (10/168), and performance of the test was not related to a better outcome. Ocular candidiasis was not associated with a worse outcome and progressed favorably in all but 1 evaluable patient, who did not experience vision loss. The low frequency of ophthalmoscopy and ocular involvement and the asymptomatic nature of ocular candidiasis, with a favorable outcome in almost all cases, lead us to reconsider the need for systematic ophthalmoscopy in all candidemic patients.

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Section: Discussionmentioning

confidence: 99%

Is routine ophthalmoscopy really necessary in candidemic patients?

et al. 2017

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“…The question of whether an ophthalmological examination of all candidemic patients is cost-effective has been raised. 15,22 Those who question this practice cite the rarity of endophthalmitis occurring with candidemia in their experience and the negative results found in patients who report no ocular symptoms. They note that patients unable to verbalize ocular symptoms and those presenting with symptoms do need an ophthalmological examination.…”

Section: Diagnosismentioning

confidence: 99%

Complications of Candidemia in ICU Patients: Endophthalmitis, Osteomyelitis, Endocarditis

Kauffman

2015

Semin Respir Crit Care Med

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Bloodstream infection with Candida species is not uncommon in the intensive care unit setting and has the potential to distribute organisms to many different organ systems causing secondary infections, such as endophthalmitis, osteomyelitis, and endocarditis. In some patients, these types of infections become manifested shortly after the episode of candidemia. In others, especially vertebral osteomyelitis, weeks pass before the diagnosis is entertained. Endophthalmitis should be sought by a retinal examination in all patients early after an episode of candidemia. Both osteomyelitis and endocarditis are less common complications of candidemia than endophthalmitis. In patients who manifest symptoms or signs suggesting these infections, magnetic resonance imaging and transesophageal echocardiography, respectively, are extremely helpful diagnostic tests. Newer approaches to the treatment of these infections allow the use of better tolerated, safer antifungal agents. Endophthalmitis is often treated with fluconazole or voriconazole, and the echinocandins are increasingly used, instead of amphotericin B, as initial therapy for osteomyelitis and endocarditis before step-down therapy to oral azole agents.

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“…21,27 In the setting of decreasing prevalence, symptom-guided screening may be contemplated and cost effectiveness of dilated ophthalmoscopy assessed. 66 Also, follow-up blood cultures should be drawn every day or every other day until demonstration of clearance of Candida from the bloodstream. International guidelines recommend antifungal treatment to be continued until 14 days after the initial negative blood culture when there are no metastatic complications.…”

Section: Additional Evaluation or Interventionmentioning

confidence: 99%

Invasive Candidiasis

González-Lara

Ostrosky-Zeichner

2020

Semin Respir Crit Care Med

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Invasive candidiasis (IC) is the most frequent health care associated invasive fungal infection. It is also associated with high morbidity, mortality, and cost. The most frequent etiologic agent is Candida albicans, but non-albicans species are increasing and associated with reduced antifungal susceptibility and outbreaks. Candida auris is an emerging multidrug-resistant species recently described. IC presents as a spectrum of disease, going from fungemia to deep-seated candidiasis, and to septic shock with multiorgan failure. Diagnosis of IC is challenging. Several biomarkers and molecular methods are available for improving diagnosis. Early initial treatment with echinocandins is the treatment of choice. Step-down therapy when antifungal susceptibility is available is possible. Several new antifungal agents for the treatment of IC are in clinical development.

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Do all candidemic patients need an ophthalmic examination?

Cited by 32 publications

References 20 publications

Is routine ophthalmoscopy really necessary in candidemic patients?

Is routine ophthalmoscopy really necessary in candidemic patients?

Complications of Candidemia in ICU Patients: Endophthalmitis, Osteomyelitis, Endocarditis

Invasive Candidiasis

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