Effect of first-line antifungal treatment on ocular complication risk in or yeast blood stream infection.

OBJECTIVES

Ocular candidiasis (OC) can complicate bloodstream infection (BSI). Antifungal treatment improves the prognosis of patients with BSI, but the effects of choice and timing of first-line medication on OC risk are incompletely understood. We explored the early treatments, risk factors and ocular presentations in BSI.

METHODS AND ANALYSIS

All patients (n=304) with BSI during 2008-2017 at Oulu University Hospital were included. Those patients in whom clinical condition was appropriate for ocular examination (OE), including biomicroscopy (n=103), were carefully analysed by ophthalmologists. Criteria for patient selection were considered. and yeast species, antifungal medications, echocardiography, underlying diseases and clinical properties of the patients with BSI were analysed.

RESULTS

Clinical condition in 103 patients had been considered appropriate for OE. OC was diagnosed in 33 of the 103 patients. was the most common finding (88%) in OC. Patients in intensive care, alcohol-related conditions or poor prognosis were less frequently examined. Persistent candidemia increased the risk of OC. Chorioretinitis and endophthalmitis were diagnosed in 94% and 48% of the patients with OC, respectively. Any early antifungal treatment decreased the endophthalmitis risk. Echinocandin lowered the OC risk in those with central venous catheters (CVCs) or abdominal malignancy.

CONCLUSION

Critical condition of patients with BSI affects the selection and results of OE. OC was associated with BSI especially among those with persistent candidemia, CVC or abdominal malignancy. Any early antifungal treatment reduced endophthalmitis risk. Early echinocandin treatment may reduce the risk of OC in selected patients.