Prevalence of Ocular Candidiasis and Candida Endophthalmitis in Patients With Candidemia: A Systematic Review and Meta-Analysis

Abstract

Background Infectious diseases and ophthalmology professional societies have disagreed regarding ocular screening in patients with candidemia. This study aimed to summarize the current evidence on the prevalence of ocular candidiasis (OC) and Candida endophthalmitis (CE) according to the standardized definitions. Methods A literature search was conducted from the 1990s through October 16th, 2022, using PubMed, Embase, and SCOPUS. Pooled prevalence of ocular complications was derived from generalized linear mixed models. (PROSPERO CRD42022326610) Results A total of 70 and 35 studies were included in the meta-analysis for OC and concordant CE (chorioretinitis with vitreous involvement), respectively. This study represented 8,599 patients with candidemia who underwent ophthalmologic examination. The pooled prevalence [95% confidence interval] of OC, overall CE, concordant CE, and discordant CE were 10.7% [8.4%-13.5%], 3.1% [2.1%-4.5%], 1.8% [1.3%-2.6%], and 7.4% [4.5%-12%] of patients screened, respectively. Studies from Asian countries had significantly higher concordant CE prevalence of patients screened [95% CI] of 3.6% [2.9% - 4.6%] compared to studies from European countries of 1.4% [0.4% - 5%] and American countries of 1.4% [0.9% - 2.2%], p-value <0.01. Presence of total parenteral nutrition and C. albicans were associated with CE with pooled odds ratios [95% CI] of 6.92 [3.58–13.36] and 3.02 [1.67–5.46], respectively. Conclusion Prevalence of concordant CE overall and among Asian countries was two-times and four-times higher than the prevalence previously reported by American Academy of Ophthalmology of < 0.9%, respectively. There is an urgent need to study optimal screening protocols and to establish joint recommendations by the Infectious Diseases and Ophthalmology Societies.

The Impact of COVID-19 on the Epidemiology and Outcomes of Candidemia: A Retrospective Study from a Tertiary Care Center in Lebanon

“…Although a recent systematic review suggested that universal ophthalmological examination does not improve outcomes [37], the Infectious Diseases Society of America (IDSA) and the European Confederation of Medical Mycology (ECMM) guidelines both recommend that all patients with candidemia should undergo routine dilated funduscopic exam [19,38]. These recommendations were supported by a recent meta-analysis by Phongkhun et al, which found that ocular manifestations in patients with candidemia were more common than previously reported by the American Academy of Ophthalmology (AAO), which suggested an incidence of less than 0.9% [39]. These discrepancies emphasize that further studies are needed to identify high-risk patients that would benefit the most from this intervention.…”

Fever and infections in surgical intensive care: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document

“… 76 These criteria based on recent data, reviews, and statements by the Royal College of Ophthalmologists and the American Academy of Ophthalmology have not yet been evaluated by the IDSA. 77 78 Patients with ocular involvement should have an infectious disease consultation.…”

Fungemia by Wickerhamomyces anomalus—A Narrative Review

“…The clinical presentation of fungemia by W. anomalus most commonly included fever and sepsis, while no patient was diagnosed with endophthalmitis in the studies evaluated in the present review. Notably, in candidemia, the rate of endophthalmitis was identified in a recent systematic review to be between 1% and 4%, depending on the geographic region where candidemia occurred [ 78 ]. The patients in the current review are relatively few, and more data are required to draw safe conclusions; however, it could be that this fungus does not have a significant tendency to cause endophthalmitis.…”