Is routine ophthalmoscopy really necessary in candidemic patients?

Vena, Antonio; Muñóz, Patricia; Padilla, Belén; Valerio, Maricela; Sánchez, Manuel; Puig-Asensio, Mireia; Fortün, Jesús; Fernández‐Ruiz, Mario; Merino, Paloma; Losa, Juan Emilio; Loza, Ana; Rivas, Raúl; Bouza, Emilio

doi:10.1371/journal.pone.0183485

Cited by 35 publications

(19 citation statements)

References 26 publications

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“…In our patients, 46% of survivors and 44% of non‐survivors underwent ophthalmoscopy, and in 4%, endophthalmitis was diagnosed. Our data support the proposition that the benefit of this diagnostic tool is questionable 26 …”

Section: Discussionsupporting

confidence: 87%

Attributable mortality of candidemia after introduction of echinocandins

Cornely

Salmanton‐García

et al. 2020

Mycoses

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Summary Objectives Candidemia is among the most frequent nosocomial bloodstream infections. Landmark case‐control studies on amphotericin B and fluconazole estimated attributable mortality rates of 38% and 49%, respectively. After introduction of echinocandins, these may have decreased. Methods In a case‐control design, 100 consecutive, hospitalised patients with candidemia were enrolled at the University Hospital of Cologne, Germany between 2014 and 2017. Controls were patients without candidemia matched for age, sex, year and duration of hospitalisation, main admission diagnosis and Patient Clinical Complexity Level (PCCL). Main data captured were risk factors for candidemia, attributable mortality rates and diagnostic and therapeutic adherence according to the EQUAL Candida score. Results Overall mortality rates for cases and controls were 43% and 17% (P < .001), respectively; day 30 mortality rates were 38% and 11% (P = .03), accounting for an attributable mortality of 26% and 27%. Guideline adherence was higher in surviving vs non‐surviving patients: while survivors reached a median of 17 (IQR: 16‐19) points, non‐surviving cases reached a median 16 (IQR: 14‐18) points out of 22 maximum achievable points (P = .028). Risk factors for candidemia were more frequent in cases compared to control patients, especially chronic pulmonary disease (25% vs 16%; P = n.s.), chronic liver disease (21% vs 6%; P = .002), stay on intensive care unit (70% vs 64%; P = n.s.), respiratory failure (56% vs 50%; P = n.s.) and central venous catheter (97% vs 35%; P < .001). Conclusions Attributable mortality of nosocomial candidemia is still substantial but has decreased compared to previous studies with similar design.

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Section: Discussionsupporting

confidence: 87%

Attributable mortality of candidemia after introduction of echinocandins

Cornely

Salmanton‐García

et al. 2020

Mycoses

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“…Consecutively, current guidelines recommend an ophthalmological examination of all patients with candidaemia [ 68 , 69 ]. However, more recent studies have reported lower OC rates, from 2.9% to 12.8%, and the necessity for routine ophthalmology consultation has been challenged [ 70 – 73 ].…”

Section: Screening For Eementioning

confidence: 99%

Endogenous Endophthalmitis: A Review of Case Series Published between 2011 and 2020

Danielescu

Anton

Stanca

et al. 2020

Journal of Ophthalmology

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This is a literature review of 31 case series of endogenous endophthalmitis (EE) published in the last ten years, identified from a literature search of several databases (PubMed, EMBASE, and the Cochrane Library). While diabetes mellitus and malignancies remain the most frequently associated medical conditions, intravenous drug use is a significant risk factor (especially in the last years, in studies from Western countries). Ophthalmologic screening is recommended for candidaemia, but not in patients with sepsis of other aetiologies (however, the physician treating patients with sepsis must be well aware of EE). The most frequent Gram-positive microorganisms that cause EE are Staphylococcus and Streptococcus; the most frequent Gram-negative organism is Pseudomonas, and yeasts, probably Candida, usually cause fungal infections. In all-cause EE, prognostic factors of better visual outcomes are initial VA better than counting fingers, performing a pars plana vitrectomy (PPV), performing an intravitreal injection within the first 24 hours after clinical diagnosis, and the presence of a focal type of EE. In endogenous fungal endophthalmitis, more than 1/4 of patients have bilateral involvement. Blood samples have a low rate of positivity. Yeasts remain the most prevalent cause. Many authors report using azoles and echinocandins for systemic therapy (and voriconazole for intravitreal injections). Although PPV was performed in small proportions of eyes, the anatomical success rate is quite high. Klebsiella pneumoniae is an important cause of EE in Southeast Asia (and probably an emergent etiology in other regions), which is frequently associated with diabetes. There is a robust association with pyogenic liver abscess (PLA) (but in up to half of the cases, the diagnosis of EE precedes that of PLA). Blood cultures have a high diagnostic yield, while vitreous samples have a low yield. K. pneumoniae may carry antibiotic resistance. Anatomical and functional success rates are small, but they may be improved with PPV.

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“…In cases in which no culture was available, the distant infection had to be temporally related with the fungemia and with no alternative cause explaining the clinical condition. Infective endocarditis was diagnosed according to the Duke criteria [17]; ocular candidiasis was classified based on previous criteria [2,5]; septic thrombophlebitis required the presence of venous thrombosis, confirmed by imaging techniques, in the setting of persistent candidemia [10].…”

Section: Definitionsmentioning

confidence: 99%

“…Candida bloodstream infection (BSI) is a lifethreating disease associated with significant morbidity, mortality and high healthcare costs. Complications are frequent [1,2], and mortality ranges between 20 and 45% [3][4][5].…”

Section: Introductionmentioning

confidence: 99%