Jung Jiwon, Lee Junyeop, Yu Shi Nae, Kim Yong Kyun, Lee Ju Young, Sung Heungsup, Kim Mi-Na, Kim Sung-Han, Lee Sang-Oh, Choi Sang-Ho, Woo Jun Hee, Lee Joo Yong, Kim Yang Soo, Chong Yong Pil
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Antimicrob Agents Chemother. 2016 Mar 25;60(4):2012-7. doi: 10.1128/AAC.02651-15. Print 2016 Apr.
Staphylococcus aureusbacteremia (SAB) often leads to ocular infections, including endophthalmitis and chorioretinitis. However, the incidence, risk factors, and outcomes of ocular infections complicated by SAB are largely unknown. We retrospectively analyzed the incidence and risk factors of ocular involvement in a prospective cohort of patients with SAB at a tertiary-care hospital. Ophthalmologists reviewed the fundoscopic findings and classified the ocular infections as endophthalmitis or chorioretinitis. During the 5-year study period, 1,109 patients had SAB, and data for 612 (55%) who underwent ophthalmic examinations within 14 days after SAB onset were analyzed. Of those 612 patients, 56 (9% [95% confidence interval [CI], 7 to 12%]) had ocular involvement, including 15 (2.5%) with endophthalmitis and 41 (6.7%) with chorioretinitis. In a multivariate analysis, infective endocarditis (adjusted odds ratio [aOR], 5.74 [95% CI, 2.25 to 14.64]) and metastatic infection (aOR, 2.38 [95% CI, 1.29 to 4.39]) were independent risk factors for ocular involvement. Of the 47 patients with ocular involvement who could communicate, only 17 (36%) had visual disturbances. Two-thirds of the patients with endophthalmitis (10/15 patients) were treated with intravitreal antibiotics combined with parenteral antibiotics, whereas all of the patients with chorioretinitis were treated only with systemic antibiotics. No patients became blind. Among 42 patients for whom follow-up assessments were available, the ocular lesions improved in 29 (69%) but remained the same in the others. Ocular involvement was independently associated with death within 30 days after SAB onset. Ocular involvement is not uncommon among patients with SAB. Routine ophthalmic examinations should be considered for patients with infective endocarditis or metastatic infections caused by SAB.
金黄色葡萄球菌血症（SAB）常导致眼部感染，包括眼内炎和脉络膜视网膜炎。然而，SAB并发眼部感染的发病率、危险因素及预后情况大多未知。我们回顾性分析了一家三级医院前瞻性队列中SAB患者眼部受累的发病率及危险因素。眼科医生检查眼底镜检查结果，并将眼部感染分为眼内炎或脉络膜视网膜炎。在为期5年的研究期间，1109例患者发生SAB，分析了其中612例（55%）在SAB发病后14天内接受眼科检查患者的数据。在这612例患者中，56例（9%[95%置信区间（CI），7%至12%]）出现眼部受累，其中15例（2.5%）为眼内炎，41例（6.7%）为脉络膜视网膜炎。多因素分析显示，感染性心内膜炎（校正比值比[aOR]，5.74[95%CI，2.25至14.64]）和转移性感染（aOR，2.38[95%CI，1.29至4.39]）是眼部受累的独立危险因素。在47例能交流的眼部受累患者中，只有17例（36%）有视觉障碍。三分之二的眼内炎患者（10/15例）接受了玻璃体内抗生素联合静脉抗生素治疗，而所有脉络膜视网膜炎患者仅接受全身抗生素治疗。无患者失明。在42例有随访评估的患者中，29例（69%）眼部病变改善，其余患者病变无变化。眼部受累与SAB发病后30天内死亡独立相关。眼部受累在SAB患者中并不少见。对于由SAB引起的感染性心内膜炎或转移性感染患者，应考虑进行常规眼科检查。
