Infection

Ocular involvement of Staphylococcus aureus bacteremia: incidence and risk factors

eye,ocular,Staphylococcus aureus,bacteremia,incidence,risk factors
Antimicrob Agents Chemother. 2016 Jan 11. pii: AAC.02651-15. [Epub ahead of print]

Ocular involvement of Staphylococcus aureus bacteremia: incidence and risk factors.

Abstract

Staphylococcus aureus bacteremia (SAB) often leads to ocular infection including endophthalmitis and chorioretinitis. However, the incidence, risk factors, and outcome of ocular infection complicated by SAB are largely unknown. We retrospectively analyzed the incidence and risk factors of ocular involvement in a prospective cohort of patients with SAB at a tertiary-care hospital. Ophthalmologists reviewed the fundoscopic findings and classified the ocular infection as endophthalmitis or chorioretinitis. During the 5 year study period, 1,109 patients had SAB and 612 (55%) who underwent ophthalmic examination within 14 days after SAB were analyzed. Of these 612 patients, 56 (9%, 95% confidence interval [CI], 7-12%) had ocular involvement; 15 (2.5%) with endophthalmitis and 41 (6.7%) with chorioretinitis. In multivariate analysis, infective endocarditis (adjusted odds ratio [aOR], 5.74; 95% CI, 2.25-14.64) and metastatic infection (aOR, 2.38; 95% CI, 1.29-4.39) were independent risk factors for ocular involvement. Of the 47 patients with ocular involvement who could communicate, only 17 (36%) had visual disturbance. Two-thirds (10/15) of the patients with endophthalmitis were treated with intravitreal antibiotics combined with parenteral antibiotics, whereas all the patients with chorioretinitis were treated with systemic antibiotics only. No one became blinded. Among 42 patients with follow-up assessment available, the ocular lesion improved in 29 (69%) but remained stationary in the others. Ocular involvement was independently associated with 30-day mortality after SAB. Ocular involvement is not uncommon in patients with SAB. Routine ophthalmic examination should be considered in patients with infective endocarditis or metastatic infection caused by SAB.

Abstract

Staphylococcus aureus bacteremia (SAB) often leads to ocular infection including endophthalmitis and chorioretinitis. However, the incidence, risk factors, and outcome of ocular infection complicated by SAB are largely unknown. We retrospectively analyzed the incidence and risk factors of ocular involvement in a prospective cohort of patients with SAB at a tertiary-care hospital. Ophthalmologists reviewed the fundoscopic findings and classified the ocular infection as endophthalmitis or chorioretinitis. During the 5 year study period, 1,109 patients had SAB and 612 (55%) who underwent ophthalmic examination within 14 days after SAB were analyzed. Of these 612 patients, 56 (9%, 95% confidence interval [CI], 7-12%) had ocular involvement; 15 (2.5%) with endophthalmitis and 41 (6.7%) with chorioretinitis. In multivariate analysis, infective endocarditis (adjusted odds ratio [aOR], 5.74; 95% CI, 2.25-14.64) and metastatic infection (aOR, 2.38; 95% CI, 1.29-4.39) were independent risk factors for ocular involvement. Of the 47 patients with ocular involvement who could communicate, only 17 (36%) had visual disturbance. Two-thirds (10/15) of the patients with endophthalmitis were treated with intravitreal antibiotics combined with parenteral antibiotics, whereas all the patients with chorioretinitis were treated with systemic antibiotics only. No one became blinded. Among 42 patients with follow-up assessment available, the ocular lesion improved in 29 (69%) but remained stationary in the others. Ocular involvement was independently associated with 30-day mortality after SAB. Ocular involvement is not uncommon in patients with SAB. Routine ophthalmic examination should be considered in patients with infective endocarditis or metastatic infection caused by SAB.