title: The incidence of ocular candidiasis and evaluation of routine opthalmic examination in critically ill patients with candidaemia.
abstract: Despite a paucity of data regarding both the incidence of ocular candidiasis and the utility of ophthalmic examination in critically ill patients, routine ophthalmic examination is recommended for critically ill patients with candidaemia. The objectives were to estimate the incidence of ocular candidiasis and evaluate whether ophthalmic examination influenced subsequent management of these patients. We conducted a ten-year retrospective observational study. Data were extracted for all ICU patients who were blood culture positive for fungal infection. Risk factors for candidaemia and eye involvement were quantified and details regarding ophthalmic examination were reviewed. Candida species were cultured in 93 patients. Risk factors for ocular candidiasis were present in 57% of patients. Forty-one percent of patients died prior to ophthalmology examination and 2% of patients were discharged before candidaemia was identified. During examination, signs of ocular candidiasis were only present in one (2.9%) patient, who had a risk factor for ocular candidiasis. Based on these findings, the duration of antifungal treatment for this patient was increased. Ocular candidiasis occurs rarely in critically ill patients with candidaemia, but because treatment regimens may be altered when diagnosed, routine ophthalmic examination is still indicated.
authors.affiliation: Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, South Australia.
authors.forename: S
authors.initials: S
authors.lastname: Gluck
authors.affiliation: University Hospital Bristol NHS Trust, Bristol, UK.
authors.forename: W G
authors.initials: WG
authors.lastname: Headdon
authors.affiliation: Modbury Hospital, Modbury, South Australia.
authors.forename: Dws
authors.initials: D
authors.lastname: Tang
authors.affiliation: SA Pathology, Adelaide, South Australia.
authors.forename: I B
authors.initials: IB
authors.lastname: Bastian
authors.affiliation: Department of Opthalmology, The Queen Elizabeth Hospital, Adelaide, South Australia.
authors.forename: M J
authors.initials: MJ
authors.lastname: Goggin
authors.affiliation: Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, South Australia.
authors.forename: A M
authors.initials: AM
authors.lastname: Deane
mesh_terms: D000328:Adult; D000368:Aged; D058387:Candidemia / Q000150:complications*; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D016638:Critical Illness; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
keywords: candidaemia; critical illness; eye infections; fungal; intensive care