Review Questions Need for Ophthalmic Screening After Candida Bloodstream Infection

By David Douglas

April 26, 2019

NEW YORK (Reuters Health) - Although candida bloodstream infection is associated with sight-threatening fungal endophthalmitis, routine ophthalmic testing does not seem to improve outcomes and might be harmful, researchers say.

"Candida bloodstream infection is a rare, but serious cause of blindness that has led to recommendations for universal ophthalmic screening of these patients by the Infectious Disease Society of America (IDSA)," Dr. John B. Bond III of Vanderbilt University Medical Center, in Nashville, Tennessee told Reuters Health by email. "Review of the literature, however, does not appear to show that ophthalmic screening leads to improved visual outcomes."

Dr. Bond and colleagues reviewed data from 38 studies involving more than 7,400 patients who underwent ophthalmologic screening for candidemia or fungemia.

They followed the conventional definition of endophthalmitis based on present (concordant) or absent (discordant) frank vitreous involvement. The incidence rate of concordant endophthalmitis (0.9%) was significantly lower than that of discordant endophthalmitis (14.6%), the team reports in JAMA Ophthalmology, online April 18.

None of the 59 concordant endophthalmitis cases showed direct, intraocular, microscopic evidence of Candida or other fungal organisms.

Outcomes data were available for only 19 cases of concordant endophthalmitis with a presumed fungal or Candida cause. Twelve patients received medical management alone and of these, six died within four weeks of screening.

None of those on medical management alone showed signs of substantial visual loss compared to 50% of those who had additional invasive intervention.

"As few as 3 of 7472 patients had potential improvement, while routine examination overall could lead to additional interventions and harm in this population," the researchers write.

"Reviewing the available data on this topic," concluded Dr. Bond, "will hopefully stimulate conversation between the infectious disease and ophthalmology communities about the proper role of ophthalmic evaluation in patients with Candida bloodstream infections and lead to revision of IDSA recommendations."

Dr. Benjamin J. Kim of the University of Pennsylvania, in Philadelphia, who wrote an accompanying editorial, told Reuters Health by email that the researchers "provide important data emphasizing just how uncommon fungal endophthalmitis is found from ophthalmology consults."

"The article appropriately points out that current screening recommendations need improvement. However, high-quality prospective data, including cost-effectiveness analyses, are needed to guide changes to current recommendations," he said.


JAMA Ophthalmol 2019.