Jessica Seidelman1, Molly Fleece2, Allison Bloom3, Emily Lydon3, Wesley Yang4, Christopher Arnold2, David J Weber5, Nwora Lance Okeke6. 1. Duke University School of Medicine, Department of Infectious Disease, Box 102359, Durham, NC 27710, United States; Duke Center for Antimicrobial Stewardship and Infection Prevention, United States. Electronic address: jessica.seidelman@duke.edu. 2. Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, United States. 3. Duke University School of Medicine, United States. 4. University of Virginia School of Medicine, United States. 5. Department of Epidemiology, University of North Carolina at Chapel Hill, United States; Department of Hospital Epidemiology, University of North Carolina Medical Center, United States. 6. Duke University School of Medicine, Department of Infectious Disease, Box 102359, Durham, NC 27710, United States. Electronic address: lance.okeke@duke.edu.
Abstract
OBJECTIVES: The Infectious Disease Society of America recommends that all patients with candidemia undergo a dilated retinal exam to exclude endogenous Candida endophthalmitis. Our objective was to determine if there are significant risk factors in candidemic patients for developing endogenous Candida endophthalmitis METHODS: We conducted a retrospective study of all candidemic patients at three academic medical centers between 2012 and 2017. We extracted risk factors for Candida endophthalmitis based on prior literature and compared them between patients with and without endophthalmitis. We then built a multivariate logistic regression model to assess which ones were significant. RESULTS: We found 771 patients with candidemia. 120 (15.6%) of these patients were diagnosed with Candida endophthalmitis. In our logistic regression analysis, central venous catheter presence (OR 8.35), intravenous drug use (OR 4.76), immunosuppression (OR 2.40), total parenteral nutrition recipient (OR 2.28), race (OR 1.65), age (OR 1.02), and gender (OR 0.57) were risk factors for developing Candida endophthalmitis. Additionally, Candida albicans was more likely to result in Candida endophthalmitis (OR 1.86). CONCLUSIONS: This cohort represents the largest study of risk factors for candidemic patients who developed endogenous Candida endophthalmitis. Based on our findings, clinicians should develop targeted and cost-effective strategies for endophthalmitis screening.
OBJECTIVES: The Infectious Disease Society of America recommends that all patients with candidemia undergo a dilated retinal exam to exclude endogenous Candida endophthalmitis. Our objective was to determine if there are significant risk factors in candidemic patients for developing endogenous Candida endophthalmitis METHODS: We conducted a retrospective study of all candidemic patients at three academic medical centers between 2012 and 2017. We extracted risk factors for Candida endophthalmitis based on prior literature and compared them between patients with and without endophthalmitis. We then built a multivariate logistic regression model to assess which ones were significant. RESULTS: We found 771 patients with candidemia. 120 (15.6%) of these patients were diagnosed with Candida endophthalmitis. In our logistic regression analysis, central venous catheter presence (OR 8.35), intravenous drug use (OR 4.76), immunosuppression (OR 2.40), total parenteral nutrition recipient (OR 2.28), race (OR 1.65), age (OR 1.02), and gender (OR 0.57) were risk factors for developing Candida endophthalmitis. Additionally, Candida albicans was more likely to result in Candida endophthalmitis (OR 1.86). CONCLUSIONS: This cohort represents the largest study of risk factors for candidemic patients who developed endogenous Candida endophthalmitis. Based on our findings, clinicians should develop targeted and cost-effective strategies for endophthalmitis screening.
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