Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, 359-8513, Japan.
Department of Laboratory Medicine, National Defense Medical College, Saitama, 359-8513, Japan.
J Infect Chemother. 2023 Nov;29(11):1081-1087. doi: 10.1016/j.jiac.2023.06.019. Epub 2023 Jun 29.
Ocular candidiasis is a major complication of candidemia that is sometimes sight-threatening. Although prompt ophthalmologic consultation and antifungal medication have been emphasized, recent changes in the causative species and drug susceptibilities make the picture unclear. This study aimed to determine whether there are trends among patients with ocular candidiasis and included 80 patients with candidemia who underwent ophthalmological screening at our hospital between 2010 and 2020. Data on the clinical characteristics, comorbidities, biochemical test results, causative Candida species, treatment, outcomes, visual acuity, and antifungal susceptibility were collected and analyzed. Statistical analyses were performed by comparing two groups, namely, the ocular candidiasis (n = 29) and non-ocular candidiasis (n = 51) groups. In the ocular candidiasis group, there were significantly more cases of central venous catheter insertion (82.8%, p = 0.026) and Candida albicans candidemia (72.4%, p < 0.001). Regarding ocular involvement, the majority of patients were asymptomatic. Most cases improved with antifungal therapy, but one case underwent vitrectomy. Between 2016 and 2020, there was a diversification of species, with a decrease in Candida parapsilosis and the emergence of Candida glabrata and Candida tropicalis. Regarding drug susceptibility, the minimum inhibitory concentrations of echinocandin and 5-fluorocytosine against Candida albicans, Candida parapsilosis, and Candida glabrata were slightly increased. In conclusion, in addition to appropriately performing ophthalmologic examinations, it is beneficial to select antifungal agents according to the diversity of species and drug susceptibilities.
眼部念珠菌病是念珠菌血症的主要并发症，有时会威胁视力。尽管已经强调了及时的眼科会诊和抗真菌药物治疗，但最近引起疾病的物种和药物敏感性的变化使得情况变得不清楚。本研究旨在确定患有眼部念珠菌病的患者是否存在趋势，并纳入了 2010 年至 2020 年期间在我院接受眼科筛查的 80 例念珠菌血症患者。收集并分析了临床特征、合并症、生化检查结果、致病念珠菌种类、治疗、结果、视力和抗真菌药物敏感性的数据。通过比较两组，即眼部念珠菌病（n=29）和非眼部念珠菌病（n=51）组，进行统计学分析。在眼部念珠菌病组中，中央静脉导管插入的病例明显更多（82.8%，p=0.026），且念珠菌血症中白色念珠菌的比例更高（72.4%，p<0.001）。关于眼部受累，大多数患者无症状。大多数病例经抗真菌治疗后有所改善，但有 1 例进行了玻璃体切除术。2016 年至 2020 年间，物种多样化，近平滑念珠菌减少，而光滑念珠菌和热带念珠菌出现。关于药物敏感性，棘白菌素和 5-氟胞嘧啶对白色念珠菌、近平滑念珠菌和光滑念珠菌的最小抑菌浓度略有增加。总之，除了适当进行眼科检查外，根据物种和药物敏感性的多样性选择抗真菌药物是有益的。
