Prevalence and factors predictive of intraocular fungal infection in patients with fungemia at an academic urban tertiary care center
Prevalence and factors predictive of intraocular fungal infection in patients with fungemia at an academic urban tertiary care center
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DOI：
10.2147/opth.s91540
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发表时间：
2015-01-01
影响因子：
2.2
通讯作者：
Brar, Vikram S.
中科院分区：
文献类型：
--
作者：
Geraymovych, Lena;Conduff, Joseph H.;Brar, Vikram S.
目的：报告接受预防性抗真菌治疗的真菌血症患者的患病率并确定预测眼内感染的因素。方法：对 2000 年至 2007 年在学术城市三级医疗中心接受预防性抗真菌治疗和散瞳眼底检查的患者进行回顾性分析。基本人口统计信息、真菌种类、使用的抗真菌药物、血培养阳性标本数量、视力、视觉症状和视力。注意到了传播性念珠菌病的已知风险。采用Logistic回归分析确定与眼内真菌感染显着相关的因素。结果：共132例真菌血症培养阳性患者要求眼科就诊。眼部感染的患病率为 6.9% (N=9)。所有九名患者均感染念珠菌。过去 6 个月内接受过胃肠道 (GI) 手术与发生眼内感染显着相关，比值比为 18.5（95% 置信区间，15.1-24.3；P=0.002）。 ≥ 3 次真菌血培养阳性也是一个显着的风险因素，优势比为 2.6（95% 置信区间，1.8-3.7；P=0.03）。在 40 名接受胃肠道手术的患者中，8 名（20.0%）患有眼内真菌病，而 92 名未接受胃肠道手术的患者中只有 1 名（1.1%）患有眼内真菌病。在 125 名基线检查结果为阴性的患者中，32 名近期接受过胃肠道手术的患者中的 2 名 (6.3%) 随后出现真菌性眼部疾病，而 93 名近期没有接受过胃肠道手术的患者中的 0 名 (0%) 随后出现真菌性眼病。结论：近期胃肠道手术和较高数量的阳性真菌血培养标本可能预示着念珠菌眼部感染。具有此类风险的患者基线眼底镜检查结果正常，可能需要重复评估以发现延迟表现。
Objective: To report the prevalence and to identify factors predictive of intraocular infection in patients with fungemia receiving prophylactic antifungal therapy.Methods: A retrospective review of patients who received prophylactic antifungal therapy and a dilated fundus examination at an academic urban tertiary care center from 2000 to 2007. Basic demographic information, fungal species grown, antifungal agent(s) used, number of positive blood culture specimens, visual acuity, visual symptoms, and known risks of disseminated candidiasis were noted. Logistic regression analysis was used to determine the factors significantly associated with intraocular fungal infection.Results: A total of 132 patients with positive fungemia culture were requested to have ophthalmology consults. The prevalence of ocular infection was 6.9% (N=9). All nine patients were infected with Candida species. Undergoing gastrointestinal (GI) surgery within the prior 6 months was significantly related to developing intraocular infection, with an odds ratio of 18.5 (95% confidence interval, 15.1-24.3; P=0.002). Having >= 3 positive fungal blood cultures was also a significant risk factor, with an odds ratio of 2.6 (95% confidence interval, 1.8-3.7; P=0.03). Among 40 patients having GI surgery, eight (20.0%) had intraocular fungal disease, compared with one of 92 patients (1.1%) not having GI surgery. Among 125 patients with a negative baseline examination result, two of 32 patients (6.3%), who had recent GI surgery, subsequently developed fungal ocular disease, compared with 0 of 93 patients (0%), who did not have recent GI surgery.Conclusion: Recent GI surgery and higher numbers of positive fungal blood culture specimens may be predictive of candida ocular infections. Normal baseline fundoscopy examination results in patients with such risks may require repeat evaluations to detect delayed manifestations.