Ophthalmology resident consultations for intraocular fungemia: A quality assurance project
What:
Paper Presentation | Présentation d'article
Part of:
When:
1:50 PM, Sunday 3 Jun 2018
(10 minutes)
Where:
How:
Authors: Crystal Cheung, Joshua Manusow, Efrem Mandelcorn
Author Disclosure Block: C. Cheung: None. J. Manusow: None. E. Mandelcorn: None.
Abstract Body:
Purpose: This study sought to prospectively review the quality of ocular candida consultations by other medical services at teaching hospitals at the University of Toronto Hospital Network. Secondary endpoints of this study included: 1) Predictive characteristics of positive ocular exams 2) Incidence of change in clinical management following ophthalmic consultations.
Study Design: A prospective cohort study was performed of consecutive adult patients from 2014-2016.
Methods: Ophthalmology residents at University of Toronto were asked to complete a short survey electronically after completion of inpatient consultations for ocular candida. The survey consisted of 5 main questions: 1) Results of the dilated fundus examination for intraocular fungus, including active chorioretinitis or endophthalmitis, 2) The presence of a positive culture (blood, peripherally inserted central catheter (PICC), urine, sputum, CSF, tissue biopsy), 3) Patient’s conscious state, 4) Visual symptoms (present, absent or unable to communicate), and 5) Change in management following ophthalmic consultation. Fischer’s exact test was used to analyze ordinal variables. Statistical significance was set at a p-value of <0.05.
Results: Seventy-eight inpatient consultations to rule out intraocular fungus were performed. Seventy-one patients (91.0%) had a positive blood culture. One patient (1.2%) had a positive urine culture, 1 patient (1.2%) had positive aspergillus from tissue biopsy, while 3 patients (3.8%) had a positive fungal culture from a PICC line. A positive blood culture compared to a positive non-blood culture (i.e. urine or tissue biopsy) was not correlated with a positive intraocular fungus examination (p=0.337). Six patients (7.69%) were diagnosed with fungal chorioretinitis or endophthalmitis on the initial examination. Of these 6 patients with a positive exam for intraocular funngus, 1 patient had visual symptoms and 5 were asymptomatic. In patients with a negative ocular examination for fungus, 37 patients were asymptomatic and 35 were intubated. In patients who could communicate, the presence of visual symptoms was significantly associated with the presence of fungal chorioretinitis or endophthalmitis (p=0.026). Among the 6 patients with intraocular fungus, 1 required intravitreal anti-fungal injections, 2 were changed from an oral to intravenous route for anti-fungal therapy, 2 required an increase in antifungal treatment duration, and 1 patient with a positive urine culture was initiated on anti-fungal therapy.
Conclusions: Approximately 91% of inpatient ophthalmology examination for intraocular fungus had a positive blood culture. The incidence of fungal chorioretinitis or endophthalmitis was 7.69% and all patients with intraocular fungus had a change in clinical management. The presence of visual symptoms was significantly associated with presence of fungal chorioretinitis or endophthalmitis (p=0.026).
Author Disclosure Block: C. Cheung: None. J. Manusow: None. E. Mandelcorn: None.
Abstract Body:
Purpose: This study sought to prospectively review the quality of ocular candida consultations by other medical services at teaching hospitals at the University of Toronto Hospital Network. Secondary endpoints of this study included: 1) Predictive characteristics of positive ocular exams 2) Incidence of change in clinical management following ophthalmic consultations.
Study Design: A prospective cohort study was performed of consecutive adult patients from 2014-2016.
Methods: Ophthalmology residents at University of Toronto were asked to complete a short survey electronically after completion of inpatient consultations for ocular candida. The survey consisted of 5 main questions: 1) Results of the dilated fundus examination for intraocular fungus, including active chorioretinitis or endophthalmitis, 2) The presence of a positive culture (blood, peripherally inserted central catheter (PICC), urine, sputum, CSF, tissue biopsy), 3) Patient’s conscious state, 4) Visual symptoms (present, absent or unable to communicate), and 5) Change in management following ophthalmic consultation. Fischer’s exact test was used to analyze ordinal variables. Statistical significance was set at a p-value of <0.05.
Results: Seventy-eight inpatient consultations to rule out intraocular fungus were performed. Seventy-one patients (91.0%) had a positive blood culture. One patient (1.2%) had a positive urine culture, 1 patient (1.2%) had positive aspergillus from tissue biopsy, while 3 patients (3.8%) had a positive fungal culture from a PICC line. A positive blood culture compared to a positive non-blood culture (i.e. urine or tissue biopsy) was not correlated with a positive intraocular fungus examination (p=0.337). Six patients (7.69%) were diagnosed with fungal chorioretinitis or endophthalmitis on the initial examination. Of these 6 patients with a positive exam for intraocular funngus, 1 patient had visual symptoms and 5 were asymptomatic. In patients with a negative ocular examination for fungus, 37 patients were asymptomatic and 35 were intubated. In patients who could communicate, the presence of visual symptoms was significantly associated with the presence of fungal chorioretinitis or endophthalmitis (p=0.026). Among the 6 patients with intraocular fungus, 1 required intravitreal anti-fungal injections, 2 were changed from an oral to intravenous route for anti-fungal therapy, 2 required an increase in antifungal treatment duration, and 1 patient with a positive urine culture was initiated on anti-fungal therapy.
Conclusions: Approximately 91% of inpatient ophthalmology examination for intraocular fungus had a positive blood culture. The incidence of fungal chorioretinitis or endophthalmitis was 7.69% and all patients with intraocular fungus had a change in clinical management. The presence of visual symptoms was significantly associated with presence of fungal chorioretinitis or endophthalmitis (p=0.026).
