Sakamoto Toru, Gotoh Kenji, Hashimoto Kenyu, Tanamachi Chiyoko, Watanabe Hiroshi
Department of Infection Control and Prevention, School of Medicine, Kurume University, Kurume 830-0011, Japan.
Department of Clinical Laboratory Medicine, Shin Koga Hospital, Kurume 830-8577, Japan.
J Fungi (Basel). 2022 May 11;8(5):497. doi: 10.3390/jof8050497.
Ocular candidiasis is a critical and challenging complication of candidemia. The purpose of this study was to investigate the appropriate timing for ophthalmologic examinations, risk factors for complications of ocular lesions, and their association with mortality. This retrospective cohort study applied, using multiple logistic regression analysis and Cox regression models, to cases of candidemia (age ≥ 18 years) for patients who underwent ophthalmologic consultation. Of the 108 candidemia patients who underwent ophthalmologic examination, 27 (25%) contracted patients had ocular candidiasis, and 7 experienced the more severe condition of endophthalmitis, which included subjective ocular symptoms. In most cases, the initial ophthalmologic examination was performed within one week of the onset of candidiasis with a diagnosis of ocular candidiasis, but in three cases, the findings became apparent only after a second examination within 7−14 days after onset of candidiasis. The independent risk factor extracted for the development of ocular candidiasis was the isolation of C. albicans (OR, 4.85; 95% CI, 1.58−14.90), unremoved CVC (OR, 10.40; 95% CI, 1.74−62.16), and a high βDG value (>108.2 pg/mL) (HR, 2.83; 95% CI = 1.24−6.27). Continuous ophthalmologic examination is recommended in cases of candidemia with the above risk factors with an initial examination within 7 days of onset and a second examination 7−14 days after onset.
眼部念珠菌病是念珠菌血症的一种严重且具有挑战性的并发症。本研究的目的是调查眼科检查的合适时机、眼部病变并发症的危险因素及其与死亡率的关联。这项回顾性队列研究采用多重逻辑回归分析和Cox回归模型，对接受眼科会诊的念珠菌血症（年龄≥18岁）患者进行研究。在108例接受眼科检查的念珠菌血症患者中，27例（25%）感染了眼部念珠菌病，7例病情更为严重，发生了眼内炎，其中包括眼部主观症状。在大多数情况下，眼部念珠菌病确诊后，首次眼科检查在念珠菌血症发病后一周内进行，但有3例患者，在念珠菌血症发病后7 - 14天进行的第二次检查时才出现明显症状。眼部念珠菌病发生的独立危险因素为白色念珠菌的分离（比值比，4.85；95%置信区间，1.58 - 14.90）、未拔除的中心静脉导管（比值比，10.40；95%置信区间，1.74 - 62.16）以及高β-D-葡聚糖值（>108.2 pg/mL）（风险比，2.83；95%置信区间 = 1.24 - 6.27）。对于存在上述危险因素的念珠菌血症患者，建议在发病7天内进行首次眼科检查，并在发病后7 - 14天进行第二次检查，之后持续进行眼科检查。
