Evaluating predictors of ocular complications and mortality in candidemia: Are repeat blood cultures key?

Candidemia can lead to ocular complications, including endophthalmitis and chorioretinitis. Management of candidemia traditionally included ophthalmic exams. However, due to concerns regarding the utility of performing ophthalmic exams in all patients, there is a need for prognostic factors suggestive of ocular complications. We sought to evaluate if positive follow-up blood cultures (FUBC) are associated with ocular involvement in candidemia. We conducted a single-center, retrospective review of candidemia cases at an academic medical center (2017-2022). Data on demographics, risk factors, ophthalmic exams, eye infection, and mortality outcomes were collected. Data was analyzed using descriptive statistics, χ2 tests, and multivariate logistic regression. A total of 238 episodes of candidemia among 199 patients were included. FUBC were obtained for 97% of cases and were positive in 35%. Ophthalmic exams were performed in 82% of cases and identified 10 endophthalmitis and 11 chorioretinitis cases. There was no significant association between positive FUBC and endophthalmitis or chorioretinitis. Ocular infections were associated with presence of any visual symptom (P < .001), Candida albicans (P = .02), C. dubliniensis (P = .003), and length of antifungal regimen (P = .007). Hospital mortality was associated with age (P < .001), C. lusitaniae (P = .056), acquisition of FUBC (P = .03), completion of an ophthalmic exam (P = .046), vasopressor use (P < .001), and length of antifungal regimen (P = .009). While positive FUBC did not correlate with ocular candidiasis, specific Candida species were associated with endophthalmitis and chorioretinitis. C. lusitaniae infections, acquisition of FUBC, and ophthalmic exam were predictors of hospital mortality. Other indications for ophthalmic evaluations and further identification of mortality risk factors need to be investigated.