University of Oulu

Hautala N, Köykkä H, Siiskonen M, et al. Effect of first-line antifungal treatment on ocular complication risk in Candida or yeast blood stream infection. BMJ Open Ophthalmology 2021;6:e000837. doi:

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

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Author: Hautala, Nina1,2; Köykkä, Hannu3; Siiskonen, Mira1,2;
Organizations: 1Department of Ophthalmology, Oulu University Hospital, Oulu, Finland
2PEDEGO Research Unit and Medical Research Center, University of Oulu, Oulu, Finland
3Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
4Nordlab, Oulu University Hospital, Oulu, Finland
5Research Unit of Biomedicine, University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
Persistent link:
Language: English
Published: BMJ, 2021
Publish Date: 2021-11-17


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.

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Series: BMJ open ophthalmology
ISSN: 2397-3269
ISSN-E: 2397-3269
ISSN-L: 2397-3269
Volume: 6
Issue: 1
Article number: e000837
DOI: 10.1136/bmjophth-2021-000837
Type of Publication: A1 Journal article – refereed
Field of Science: 3125 Otorhinolaryngology, ophthalmology
Copyright information: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: