Vitreoretinal Involvement in Patients With Fungemia at a Tertiary Care Hospital

Abstract

Purpose: To identify the prevalence of fungal ophthalmic involvement and evaluate risk factors for positive screening for inpatients at an academic tertiary care hospital by assessing a priori screening criteria that may determine which patients need ophthalmic evaluation. Methods: This retrospective cohort study comprised patients with a documented positive blood culture for fungemia and an ophthalmic screening examination from January 1, 2015, to September 30, 2019. Ophthalmology notes and laboratory results taken during admission were evaluated. The primary outcomes were ocular involvement, the presence of visual complaints, and the duration of blood culture positivity. Variables assessed included recent gastrointestinal surgery, organ transplantation, HIV infection, diabetes mellitus, intravenous drug use, and central venous access. Analyses, including the Student t test, χ² test, and logistic regression, were performed. Results: Of 291 patients with fungemia, 7 had ocular involvement (3 with chorioretinitis; 4 with endophthalmitis). One patient with endophthalmitis required an intravitreal antifungal injection. No patient with chorioretinitis required injections or surgery. The mean culture positivity length was 5 days for those with vitreoretinal involvement and 4 days for those without vitreoretinal involvement (P > .05). Of patients with ocular involvement, 40.0% had a visual complaint compared with 4.2% without ocular involvement (P < .05). The negative predictive value was 99.3% for patients without complaints or persistent fungemia. Conclusions: Patients with visual complaints at the time of a positive blood culture for fungemia are at risk for ocular disease and require screening.