Risk factors predictive of endogenous endophthalmitis among hospitalized patients with hematogenous infections in the United States.

PURPOSE To identify potential risk factors associated with endogenous endophthalmitis among hospitalized patients with hematogenous infections. DESIGN Retrospective cross-sectional study. METHODS MarketScan Commercial Claims and Encounters, and Medicare Supplemental and Coordination of Benefit inpatient databases from the years 2007-2011 were obtained. Utilizing ICD-9 codes, logistic regression was used to identify potential predictors/comorbidities for developing endophthalmitis in patients with hematogenous infections. RESULTS Among inpatients with hematogenous infections, the overall incidence rate of presumed endogenous endophthalmitis was 0.05%-0.4% among patients with fungemia and 0.04% among patients with bacteremia. Comorbid human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) (OR = 4.27; CI, 1.55-11.8; P = .005), tuberculosis (OR = 8.5; CI, 1.2-61.5; P = .03), endocarditis (OR = 8.3; CI, 4.9-13.9; P < .0001), bacterial meningitis (OR = 3.8; CI, 1.2-12.0; P = .023), fungal meningitis (OR = 59.1; CI, 14.1-247.8; P < .0001), internal organ abscess (OR = 2.9; CI, 1.2-6.4; P = .02), lymphoma/leukemia (OR = 2.9; CI, 1.6-5.3; P < .0001), skin abscess/cellulitis (OR = 1.75; CI, 1.1-2.8; P = .02), pyogenic arthritis (OR = 4.2; CI, 1.8-9.6; P = .001), diabetes with ophthalmic manifestations (OR = 7.0; CI, 1.7-28.3; P = .006), and urinary tract infection (OR = 0.04; CI, 0.3-0.9; P = .023) were each significantly associated with a diagnosis of endogenous endophthalmitis. Patients aged 0-17 years (OR = 2.61; CI, 1.2-5.7; P = .02), 45-54 years (OR = 3.4; CI, 2.0-5.4; P < .0001), and 55-64 years (OR = 2.9; CI, 1.8-4.8; P < .0001); those having length of stay of 3-10 days (OR = 1.9; CI, 1.1-3.3; P = .01), 11-30 days (OR = 3.1; CI, 1.8-5.5; P < .0001), and 31+ days (OR = 5.3; CI, 2.7-10.4; P < .0001); and those with intensive care unit/neonatal intensive care unit (ICU/NICU) admissions (OR = 1.5; CI, 1.4-1.6; P < .0001) were all more likely to be diagnosed with endogenous endophthalmitis. CONCLUSIONS Endogenous endophthalmitis is rare among hospitalized patients in the United States. Among patients with hematogenous infections, odds of endogenous endophthalmitis were higher for children and middle-aged patients, and for patients with endocarditis, bacterial meningitis, lymphoma/leukemia, HIV/AIDS, internal organ abscess, diabetes with ophthalmic manifestations, skin cellulitis/abscess, pyogenic arthritis, tuberculosis, longer hospital stays, and/or ICU/NICU admission.

[1]  E. Bouza,et al.  A prospective search for ocular lesions in hospitalized patients with significant bacteremia. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[2]  S. Chee,et al.  Endogenous endophthalmitis , 2001, Current opinion in ophthalmology.

[3]  John W. Miller,et al.  Retinal Lesions as Clues to Disseminated Bacterial and Candidal Infections: Frequency, Natural History, and Etiology , 2003, Medicine.

[4]  H. Flynn,et al.  Treatment outcomes in a 10-year study of endogenous fungal endophthalmitis. , 1997, Ophthalmic surgery and lasers.

[5]  Timothy L. Jackson,et al.  Systematic review of 342 cases of endogenous bacterial endophthalmitis. , 2014, Survey of ophthalmology.

[6]  H. Flynn,et al.  Endogenous fungal endophthalmitis: causative organisms, management strategies, and visual acuity outcomes. , 2012, American journal of ophthalmology.

[7]  C. Lowder,et al.  Should all patients with candidaemia have an ophthalmic examination to rule out ocular candidiasis? , 2000, Eye.

[8]  L. Gentry,et al.  Endogenous endophthalmitis among patients with candidemia. , 1982, Ophthalmology.

[9]  R. Brooks,et al.  Prospective study of Candida endophthalmitis in hospitalized patients with candidemia. , 1989, Archives of internal medicine.

[10]  M. Spirn,et al.  Ocular candidiasis: a review , 2008, British Journal of Ophthalmology.

[11]  E. O'Neill,et al.  Endogenous endophthalmitis: 10-year experience at a tertiary referral centre , 2011, Eye.

[12]  T. Friberg,et al.  Vitreous cultures in suspected endophthalmitis. Biopsy or vitrectomy? , 1993, Ophthalmology.

[13]  J. Wolter.  Endogenous fungus endophthalmitis caused by Candida albicans. , 1962, Archives of ophthalmology.

[14]  H. Flynn,et al.  Culture-proven endogenous endophthalmitis: clinical features and visual acuity outcomes. , 2004, American journal of ophthalmology.

[15]  F. Pien.  The incidence of fundus lesions in septicemia. , 1980, American journal of ophthalmology.

[16]  David M. Adamson,et al.  HealtH ReseaRcH Data foR tHe Real WoRlD: tHe MaRketscan ® Databases , 2008 .

[17]  W. Liles,et al.  Endogenous bacterial endophthalmitis. Report of a ten-year retrospective study. , 1994, Ophthalmology.

[18]  J. Edwards,et al.  OCULAR MANIFESTATIONS OF CANDIDA SEPTICEMIA: REVIEW OF SEVENTY-SIX CASES OF HEMATOGENOUS CANDIDA ENDOPHTHALMITIS , 1974, Medicine.

[19]  M. Neudorfer,et al.  Retinal lesions in septicemia. , 1993, American journal of ophthalmology.

[20]  S. Eykyn,et al.  Endogenous bacterial endophthalmitis: a 17-year prospective series and review of 267 reported cases. , 2003, Survey of ophthalmology.

[21]  D. Henderson,et al.  Hematogenous candida endophthalmitis in patients receiving parenteral hyperalimentation fluids. , 1981, The Journal of infectious diseases.

[22]  P. Kaiser,et al.  Endogenous Endophthalmitis: An 18-Year Review of Culture-Positive Cases at a Tertiary Care Center , 2003, Medicine.

[23]  D. Selva,et al.  Endogenous endophthalmitis: A 13-year review at a tertiary hospital in South Australia , 2005, Scandinavian journal of infectious diseases.