Effect of first-line antifungal treatment on ocular complication risk in Candida or yeast blood stream infection

Objectives Ocular candidiasis (OC) can complicate Candida bloodstream infection (BSI). Antifungal treatment improves the prognosis of patients with BSI, but the effects of choice and timing of first-line medication on OC risk are incompletely understood. We explored the early treatments, risk factors and ocular presentations in Candida BSI. Methods and analysis All patients (n=304) with Candida BSI during 2008–2017 at Oulu University Hospital were included. Those patients in whom clinical condition was appropriate for ocular examination (OE), including biomicroscopy (n=103), were carefully analysed by ophthalmologists. Criteria for patient selection were considered. Candida and yeast species, antifungal medications, echocardiography, underlying diseases and clinical properties of the patients with Candida BSI were analysed. Results Clinical condition in 103 patients had been considered appropriate for OE. OC was diagnosed in 33 of the 103 patients. Candida albicans was the most common finding (88%) in OC. Patients in intensive care, alcohol-related conditions or poor prognosis were less frequently examined. Persistent candidemia increased the risk of OC. Chorioretinitis and endophthalmitis were diagnosed in 94% and 48% of the patients with OC, respectively. Any early antifungal treatment decreased the endophthalmitis risk. Echinocandin lowered the OC risk in those with central venous catheters (CVCs) or abdominal malignancy. Conclusion Critical condition of patients with Candida BSI affects the selection and results of OE. OC was associated with C. albicans BSI especially among those with persistent candidemia, CVC or abdominal malignancy. Any early antifungal treatment reduced endophthalmitis risk. Early echinocandin treatment may reduce the risk of OC in selected patients.