The Incidence of Ocular Complications in Candidemic Patients and Implications for the Practice of Routine Eye Exams.
The Incidence of Ocular Complications in Candidemic Patients and Implications for the Practice of Routine
Eye Exams.
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DOI：
10.1093/ofid/ofac045
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发表时间：
2022-04
影响因子：
4.2
通讯作者：
Apewokin S
中科院分区：
文献类型：
--
作者：
Hillenbrand M;Mendy A;Patel K;Wilkinson R;Liao S;Robertson J;Apewokin S
眼球念珠菌病是已知的念珠菌血症的并发症。鉴于棘球蛋白的眼部渗透性较差，有人担心，棘球蛋白使用量的增加可能预示着眼部并发症的发生率增加。我们研究了抗真菌药物处方模式的变化趋势和念珠菌感染后眼部并发症的发生率。对2014年1月至2020年6月间接受眼科医生筛查眼底镜检查的血培养念珠菌阳性患者进行了分析。χ2分析用于比较2016年前后的抗真菌处方和眼科检查结果。还进行了趋势分析，以评估处方实践和眼科检查结果的时间变化。在研究期间有226例念珠菌血症病例，其中129例(57.1%)接受了筛查眼科检查。从2014年到2015年，37名患者中有24名(64.5%)接受了穿透性抗真菌药物治疗，而2016年至2020年，92名患者中有36名(39.1%)接受了穿透性抗真菌药物(P = .008)。总体而言，129名患者中有30名(23.3%)有异常眼科检查，2016年前异常眼科检查的患病率为37人中有7人(18.9%)，而2016年后为92人中有23人(25%，P = .46)。趋势分析显示，在研究期间，异常眼部发现有所增加(P = .008)。在30名眼科检查异常的患者中，9名(30%)的患者全身抗真菌治疗从棘球菌素改为穿眼抗真菌药。Echinocandin的使用与异常的眼部发现有关。自2016年以来，治疗念珠菌症的穿眼抗真菌药物处方一直呈下降趋势。这与筛查眼底镜异常发现的增加有关。在整个研究期间，眼睛检查异常的情况并不少见。在一项单一机构对念珠菌血症患者的回顾性研究中，在过去的5年中，接受眼穿透性抗真菌药物治疗的患者较少。在这段时间内，筛查眼底镜检查的异常发现也有所增加。
Ocular candidiasis is a known complication of candidemia. Given the poor ocular penetration of echinocandins, there is some concern that the increasing use of echinocandins may portend an increased incidence of ophthalmic complications. We examined the changing trends in antifungal prescribing patterns and the incidence of ophthalmic complications after candidemia. Patients with blood cultures positive for Candida species between January 2014 and June 2020 who underwent screening fundoscopic examination by an ophthalmologist were analyzed. The χ2 analysis was used to compare antifungal prescriptions and ocular exam findings before and after 2016. Trend analysis was also performed to assess temporal changes in prescribing practices and eye exam findings. There were 226 candidemia cases during the study period, 129 (57.1%) of which underwent screening eye exams. From 2014 to 2015, 24 of 37 (64.5%) patients received eye-penetrating antifungals compared to 36 of 92 (39.1%) from 2016 to 2020 (P = .008). Overall, 30 of 129 (23.3%) patients had abnormal eye exams with the prevalence of abnormal findings being 7 of 37 (18.9%) before 2016 compared to 23 of 92 (25%, P = .46) thereafter. A trend analysis revealed an increase in abnormal eye findings over the study period (P = .008). Of the 30 patients who had abnormal eye exams, 9 (30%) had a change in systemic antifungal therapy from echinocandins to eye-penetrating antifungals. Echinocandin use was associated with abnormal eye findings. Prescription of eye-penetrating antifungals for candidemia has trended down since 2016. This was associated with a concomitant increase in abnormal findings on screening fundoscopy. Abnormal eye exams were not uncommon throughout our study period. In a single institution retrospective study of patients with candidemia, fewer patients received eye-penetrating antifungals over the past 5 years. Within this time period, there has also been an increase in abnormal findings on screening fundoscopic exam.
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影响因子：
3.3
作者：
Huynh, Nancy;Chang, Han-Ying Peggy;Borboli-Gerogiannis, Sheila
通讯作者：
Borboli-Gerogiannis, Sheila
影响因子：
8.1
作者：
Tirpack, Aubrey R.;Duker, Jay S.;Baumal, Caroline R.
通讯作者：
Baumal, Caroline R.
影响因子：
2.2
作者：
Geraymovych, Lena;Conduff, Joseph H.;Brar, Vikram S.
通讯作者：
Brar, Vikram S.
DOI：
10.1016/j.diagmicrobio.2017.02.014
发表时间：
2017-06-01
影响因子：
2.9
作者：
Munoz, P.;Vena, A.;Bouza, E.
通讯作者：
Bouza, E.
影响因子：
13.7
作者：
DONAHUE, SP;GREVEN, CM;LU, VL
通讯作者：
LU, VL