{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T19:58:56Z","timestamp":1789415936136,"version":"build-2803163510"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2022,3,19]],"date-time":"2022-03-19T00:00:00Z","timestamp":1647648000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30 ES006096"],"award-info":[{"award-number":["P30 ES006096"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K08CA237735"],"award-info":[{"award-number":["K08CA237735"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ocular candidiasis is a known complication of candidemia. Given the poor ocular penetration of echinocandins, there is some concern that the increasing use of echinocandins may portend an increased incidence of ophthalmic complications. We examined the changing trends in antifungal prescribing patterns and the incidence of ophthalmic complications after candidemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with blood cultures positive for Candida species between January 2014 and June 2020 who underwent screening fundoscopic examination by an ophthalmologist were analyzed. The \u03c72 analysis was used to compare antifungal prescriptions and ocular exam findings before and after 2016. Trend analysis was also performed to assess temporal changes in prescribing practices and eye exam findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 226 candidemia cases during the study period, 129 (57.1%) of which underwent screening eye exams. From 2014 to 2015, 24 of 37 (64.5%) patients received eye-penetrating antifungals compared to 36 of 92 (39.1%) from 2016 to 2020 (P\u2005=\u2005.008). Overall, 30 of 129 (23.3%) patients had abnormal eye exams with the prevalence of abnormal findings being 7 of 37 (18.9%) before 2016 compared to 23 of 92 (25%, P\u2005=\u2005.46) thereafter. A trend analysis revealed an increase in abnormal eye findings over the study period (P\u2005=\u2005.008). Of the 30 patients who had abnormal eye exams, 9 (30%) had a change in systemic antifungal therapy from echinocandins to eye-penetrating antifungals. Echinocandin use was associated with abnormal eye findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Prescription of eye-penetrating antifungals for candidemia has trended down since 2016. This was associated with a concomitant increase in abnormal findings on screening fundoscopy. Abnormal eye exams were not uncommon throughout our study period.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofac045","type":"journal-article","created":{"date-parts":[[2022,3,19]],"date-time":"2022-03-19T10:01:41Z","timestamp":1647684101000},"source":"Crossref","is-referenced-by-count":18,"title":["The Incidence of Ocular Complications in Candidemic Patients and Implications for the Practice of Routine &amp;#x2028;Eye Exams"],"prefix":"10.1093","volume":"9","author":[{"given":"Molly","family":"Hillenbrand","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Duke University, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelico","family":"Mendy","sequence":"additional","affiliation":[{"name":"Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavya","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Racheal","family":"Wilkinson","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siyun","family":"Liao","sequence":"additional","affiliation":[{"name":"University of Cincinnati College of Pharmacy, Cincinnati, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Robertson","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3915-5814","authenticated-orcid":false,"given":"Senu","family":"Apewokin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,3,19]]},"reference":[{"key":"2022032913363988000_CIT0001","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/civ933","article-title":"Clinical practice guideline for the management of Candidiasis: 2016 update by the Infectious Diseases Society of America.","volume":"62","author":"Pappas","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2022032913363988000_CIT0002","doi-asserted-by":"crossref","first-page":"100","DOI":"10.3109\/09273948.2011.646383","article-title":"Ocular involvement in hospitalized patients with candidemia: analysis at a Boston tertiary care center.","volume":"20","author":"Huynh","year":"2012","journal-title":"Ocul Immunol Inflamm"},{"key":"2022032913363988000_CIT0003","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1001\/jamaophthalmol.2019.0733","article-title":"Utility of ophthalmologic screening for patients with Candida bloodstream infections: a systematic review.","volume":"137","author":"Breazzano","year":"2019","journal-title":"JAMA Ophthalmol"},{"key":"2022032913363988000_CIT0004","doi-asserted-by":"crossref","first-page":"e0183485","DOI":"10.1371\/journal.pone.0183485","article-title":"Is routine ophthalmoscopy really necessary in candidemic patients?","volume":"12","author":"Vena","year":"2017","journal-title":"PLoS One"},{"key":"2022032913363988000_CIT0005","doi-asserted-by":"crossref","first-page":"e146","DOI":"10.1016\/j.ijid.2012.12.014","article-title":"Do all candidemic patients need an ophthalmic examination?","volume":"17","author":"Vinikoor","year":"2013","journal-title":"Int J Infect Dis"},{"key":"2022032913363988000_CIT0006","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1086\/380796","article-title":"Guidelines for treatment of candidiasis.","volume":"38","author":"Pappas","year":"2004","journal-title":"Clin Infect Dis"},{"key":"2022032913363988000_CIT0007","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1007\/s15010-018-1163-z","article-title":"Prevalence of, and risk factors for, hematogenous fungal endophthalmitis in patients with Candida bloodstream infection.","volume":"46","author":"Kato","year":"2018","journal-title":"Infection"},{"key":"2022032913363988000_CIT0008","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1016\/j.ophtha.2011.01.038","article-title":"Fungal eye disease at a tertiary care center: the utility of routine inpatient consultation.","volume":"118","author":"Dozier","year":"2011","journal-title":"Ophthalmology"},{"key":"2022032913363988000_CIT0009","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.ophtha.2021.07.015","article-title":"American Academy of Ophthalmology recommendations on screening for endogenous Candida endophthalmitis.","volume":"129","author":"Breazzano","year":"2022","journal-title":"Ophthalmology"},{"key":"2022032913363988000_CIT0010","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1080\/09273948.2017.1381271","article-title":"Ocular involvement in patients with fungemia in an urban tertiary care center.","volume":"27","author":"Price","year":"2019","journal-title":"Ocul Immunol Inflamm"},{"key":"2022032913363988000_CIT0011","first-page":"1853","article-title":"Prevalence and factors predictive of intraocular fungal infection in patients with fungemia at an academic urban tertiary care center.","volume":"9","author":"Geraymovych","year":"2015","journal-title":"Clin Ophthalmol"},{"key":"2022032913363988000_CIT0012","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1016\/j.ajo.2015.07.033","article-title":"Inpatient ophthalmology consultation for fungemia: prevalence of ocular involvement and necessity of funduscopic screening.","volume":"160","author":"Adam","year":"2015","journal-title":"Am J Ophthalmol"},{"key":"2022032913363988000_CIT0013","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1093\/cid\/cir355","article-title":"Ocular manifestations of candidemia.","volume":"53","author":"Oude Lashof","year":"2011","journal-title":"Clin Infect Dis"},{"key":"2022032913363988000_CIT0014","article-title":"Incidence of chorioretinitis and endophthalmitis in hospitalized patients with fungemia.","author":"Siddiqui","year":"2021","journal-title":"Eye (Lond)"},{"key":"2022032913363988000_CIT0015","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1128\/CMR.00046-13","article-title":"Tissue penetration of antifungal agents.","volume":"27","author":"Felton","year":"2014","journal-title":"Clin Microbiol Rev"},{"key":"2022032913363988000_CIT0016","doi-asserted-by":"crossref","first-page":"4027","DOI":"10.1128\/AAC.02300-12","article-title":"Intraocular penetration of intravenous micafungin in inflamed human eyes.","volume":"57","author":"Mochizuki","year":"2013","journal-title":"Antimicrob Agents Chemother"},{"key":"2022032913363988000_CIT0017","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1001\/jamaophthalmol.2017.0650","article-title":"An outbreak of endogenous fungal endophthalmitis among intravenous drug abusers in New England.","volume":"135","author":"Tirpack","year":"2017","journal-title":"JAMA Ophthalmol"},{"key":"2022032913363988000_CIT0018","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.diagmicrobio.2017.02.014","article-title":"No evidence of increased ocular involvement in candidemic patients initially treated with echinocandins.","volume":"88","author":"Mu\u00f1oz","year":"2017","journal-title":"Diagn Microbiol Infect Dis"},{"key":"2022032913363988000_CIT0019","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1016\/S0161-6420(94)31175-4","article-title":"Intraocular candidiasis in patients with candidemia. Clinical implications derived from a prospective multicenter study.","volume":"101","author":"Donahue","year":"1994","journal-title":"Ophthalmology"},{"key":"2022032913363988000_CIT0020","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofab516","article-title":"Candida endophthalmitis treated successfully with isavuconazole - a case report.","volume":"8","author":"Sng","year":"2021","journal-title":"Open Forum Infect Dis"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofac045\/42955351\/ofac045.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/9\/4\/ofac045\/43058286\/ofac045.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/9\/4\/ofac045\/43058286\/ofac045.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T09:49:02Z","timestamp":1648547342000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofac045\/6550859"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,19]]},"references-count":20,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,4,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofac045","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,4,1]]},"published":{"date-parts":[[2022,3,19]]},"article-number":"ofac045"}}