Endogenous Candida endophthalmitis: Who is really at risk?
Open accessAbstract
Objectives The Infectious Disease Society of America recommends that all patients with candidemia undergo a dilated retinal exam to exclude endogenous Candida endophthalmitis. Our objective was to determine if there are significant risk factors in candidemic patients for developing endogenous Candida endophthalmitis METHODS: We conducted a retrospective study of all candidemic patients at three academic medical centers between 2012 and 2017. We extracted risk factors for Candida endophthalmitis based on prior literature and compared them between patients with and without endophthalmitis. We then built a multivariate logistic regression model to assess which ones were significant.Results We found 771 patients with candidemia. 120 (15.6%) of these patients were diagnosed with Candida endophthalmitis. In our logistic regression analysis, central venous catheter presence (OR 8.35), intravenous drug use (OR 4.76), immunosuppression (OR 2.40), total parenteral nutrition recipient (OR 2.28), race (OR 1.65), age (OR 1.02), and gender (OR 0.57) were risk factors for developing Candida endophthalmitis. Additionally, Candida albicans was more likely to result in Candida endophthalmitis (OR 1.86).Conclusions This cohort represents the largest study of risk factors for candidemic patients who developed endogenous Candida endophthalmitis. Based on our findings, clinicians should develop targeted and cost-effective strategies for endophthalmitis screening.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Racial minority groups had a higher risk for Candida endophthalmitis than white patients (OR 1.65, 95% CI 1.07 to 2.55).
“Other similar findings were reported in an observational study that found that racial minority groups had a higher risk for Candida endophthalmitis than white patients (OR 1.65, 95% CI 1.07 to 2.55) [113].”
From Race and ethnicity: Risk factors for fungal infections? (2023) · cites this paper as [113]
Cites
Pappas, P. G., Kauffman, C. A., Andes, D. R., Clancy, C. J., Marr, K. A., Ostrosky-Zeichner, L., Reboli, A. C., Schuster, M. G., Vazquez, J. A., Walsh, T. J., et al. (2016) · Clinical Infectious Diseases · doi:10.1093/cid/civ933 · Cited by 4,200 · see citing works
Grasselli, G., Greco, M., Zanella, A., Albano, G., Antonelli, M. M., Bellani, G., Bonanomi, E., Cabrini, L., Carlesso, E., Castelli, G. P., et al. (2020) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2020.3539 · Cited by 1,608 · see citing works
Epidemiology of Invasive Mycoses in North America
Pfaller, M. A., & Diekema, D. J. (2010) · Critical Reviews in Microbiology · doi:10.3109/10408410903241444 · Cited by 901 · see citing works
Zaoutis, T. E., Argon, J., Chu, J., Berlin, J. A., Walsh, T. J., & Feudtner, C. (2005) · Clinical Infectious Diseases · doi:10.1086/496922 · Cited by 784 · see citing works
Bacterial and Fungal Endophthalmitis
Durand, M. L. (2017) · Clinical Microbiology Reviews · doi:10.1128/cmr.00113-16 · Cited by 526 · see citing works
Cleveland, A. A., Farley, M. M., Harrison, L. H., Stein, B., Hollick, R., Lockhart, S. R., Magill, S. S., Derado, G., Park, B. J., & Chiller, T. M. (2012) · Clinical Infectious Diseases · doi:10.1093/cid/cis697 · Cited by 366 · see citing works
Fungal and Parasitic Infections of the Eye
Klotz, S. A., Penn, C. C., Negvesky, G. J., & Butrus, S. I. (2000) · Clinical Microbiology Reviews · doi:10.1128/cmr.13.4.662-685.2000 · Cited by 311 · see citing works
Edwards, J. E., Foos, R. Y., Montgomerie, J. Z., & Guze, L. B. (1974) · Medicine · doi:10.1097/00005792-197401000-00002 · Cited by 303 · see citing works
Kresloff, M., CASTELLARIN, A. A., & Zarbin, M. A. (1998) · Survey of Ophthalmology · doi:10.1016/s0039-6257(98)00036-8 · Cited by 290 · see citing works
Culture-proven endogenous endophthalmitis: clinical features and visual acuity outcomes
Schiedler, V., Scott, I. U., Flynn, H. W., Davis, J. L., Benz, M. S., & Miller, D. (2004) · American Journal of Ophthalmology · doi:10.1016/j.ajo.2003.11.013 · Cited by 243 · see citing works
Intraocular Candidiasis in Patients with Candidemia
Donahue, S. P., Greven, C. M., Zuravleff, J. J., Eller, A. W., Nguyen, M. H., Peacock, J. E., Wagener, M. M., & Yu, V. L. (1994) · Ophthalmology · doi:10.1016/s0161-6420(94)31175-4 · Cited by 239 · see citing works
Ocular manifestations of candidemia
Oude Lashof, A. M. L., Rothova, A., Sobel, J. D., Ruhnke, M., Pappas, P. G., Viscoli, C., Schlamm, H. T., Oborska, I. T., Rex, J. H., & Kullberg, B. J. (2011) · Clinical Infectious Diseases · doi:10.1093/cid/cir355 · Cited by 218 · see citing works
An, C., Lim, H., Kim, D. W., Chang, J. H., Choi, Y. J., & Kim, S. W. (2020) · Scientific Reports · doi:10.1038/s41598-020-75767-2 · Cited by 190 · see citing works
Prospective Study of Candida Endophthalmitis in Hospitalized Patients With Candidemia
Brooks, R. G. (1989) · Archives of Internal Medicine · doi:10.1001/archinte.1989.00390100056014 · Cited by 174 · see citing works
Endogenous Endophthalmitis Among Patients with Candidemia
Parke, D. W., Jones, D. B., & Gentry, L. O. (1982) · Ophthalmology · doi:10.1016/s0161-6420(82)34722-3 · Cited by 167 · see citing works
Retinal Lesions as Clues to Disseminated Bacterial and Candidal Infections
Rodríguez-Adrián, L. J., King, R. T., Tamayo-Derat, L. G., Miller, J. W., GARCIA, C. A., & Rex, J. H. (2003) · Medicine · doi:10.1097/01.md.0000076008.64510.f1 · Cited by 114 · see citing works
Should all patients with candidaemia have an ophthalmic examination to rule out ocular candidiasis?
Krishna, R., Amuh, D., Lowder, C. Y., Gordon, S. M., Adal, K. A., & Hall, G. S. (2000) · Eye · doi:10.1038/eye.2000.7 · Cited by 91 · see citing works
Estrogen Effects onCandida albicans:A Potential Virulence‐Regulating Mechanism
Zhang, X., Essmann, M., Burt, E. T., & Larsen, B. (2000) · The Journal of Infectious Diseases · doi:10.1086/315406 · Cited by 88 · see citing works
Martínez-Vázquez, C., Fernández-Ulloa, J., Bordón, J., SOPEÑA, B., de la Fuente, J., Ocampo, A., & Rubianes, M. (1998) · Clinical Infectious Diseases · doi:10.1086/514972 · Cited by 87 · see citing works
Tanaka, M., KOBAYASHI, Y., Takebayashi, H., KIYOKAWA, M., & QIU, H. (2001) · Retina · doi:10.1097/00006982-200106000-00001 · Cited by 81 · see citing works
Liang, X., Shi, L., Wang, Y., Xiao, W., Duan, G., Yang, H., & Wang, Y. (2020) · Journal of Infection · doi:10.1016/j.jinf.2020.06.060 · Cited by 75 · see citing works
European expert opinion on the management of invasive candidiasis in adults
Kullberg, B. J., Verweij, P. E., Akova, M., Arendrup, M. C., Billé, J., Calandra, T., Cuenca‐Estrella, M., Herbrecht, R., Jacobs, F., Kalin, M., et al. (2011) · Clinical Microbiology and Infection · doi:10.1111/j.1469-0691.2011.03615.x · Cited by 72 · see citing works
An Outbreak of Endogenous Fungal Endophthalmitis Among Intravenous Drug Abusers in New England
Tirpack, A. R., Duker, J. S., & Baumal, C. R. (2017) · JAMA Ophthalmology · doi:10.1001/jamaophthalmol.2017.0650 · Cited by 71 · see citing works
Kato, H., Yoshimura, Y., Suido, Y., Ide, K., Sugiyama, Y., Matsuno, K., & Nakajima, H. (2018) · Infection · doi:10.1007/s15010-018-1163-z · Cited by 51 · see citing works
ENDOGENOUS ENDOPHTHALMITIS ASSOCIATED WITH INTRAVENOUS DRUG ABUSE
Connell, P., O’Neill, E. C., Islam, A. F. M., Buttery, R., McCombe, M. F., Essex, R. W., Roufail, E., Lash, S. C., Wolffe, B., Clark, B., et al. (2010) · Retina · doi:10.1097/iae.0b013e3181dd6db6 · Cited by 44 · see citing works
Angiotensin converting enzyme genotypes and mortality from COVID-19: An ecological study
Aung, A. K., Aitken, T., Teh, B. M., Yu, C., Ofori‐Asenso, R., Chin, K. L., & Liew, D. (2020) · Journal of Infection · doi:10.1016/j.jinf.2020.11.012 · Cited by 37 · see citing works
Do all candidemic patients need an ophthalmic examination?
Vinikoor, M. J., Zoghby, J., Cohen, K. L., & Tucker, J. D. (2013) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2012.12.014 · Cited by 31 · see citing works
Mayer, M. Á., Vidal‐Alaball, J., Puigdellívol‐Sánchez, A., Marin-Gomez, F. X., Leis, Á., & Mendioroz, J. (2021) · JMIR Public Health and Surveillance · doi:10.2196/25452 · Cited by 28 · see citing works
Incidence and Clinical Predictors of Ocular Candidiasis in Patients withCandidaFungemia
Khalid, A., Clough, L. A., Symons, R. C. A., Mahnken, J. D., Dong, L., & Eid, A. J. (2014) · Interdisciplinary Perspectives on Infectious Diseases · doi:10.1155/2014/650235 · Cited by 27 · see citing works
Huynh, N., Chang, H.-Y. P., & Borboli-Gerogiannis, S. (2012) · Ocular Immunology and Inflammation · doi:10.3109/09273948.2011.646383 · Cited by 26 · see citing works
Endogenous candidal endophthalmitis.
Deutsch, D., Adler, S., Teller, J., & Savir, H. (1989) · PubMed · Cited by 16 · see citing works
Popovich, K. J., Malani, P., Kauffman, C. A., & Cinti, S. K. (2007) · Infectious Diseases in Clinical Practice · doi:10.1097/ipc.0b013e318059b95f · Cited by 11 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Breazzano, M. P., Bond, J. B., Bearelly, S., Kim, D. H., Donahue, S. P., Lum, F., & Olsen, T. W. (2021) · Ophthalmology · doi:10.1016/j.ophtha.2021.07.015 · Cited by 82 · see citing works
Race and ethnicity: Risk factors for fungal infections?
Jenks, J. D., Aneke, C. I., Al-Obaidi, M. M., Egger, M., Garcia, L., Gaines, T., Hoenigl, M., & Thompson, G. R. (2023) · PLOS Pathogens · doi:10.1371/journal.ppat.1011025 · Cited by 55 · see citing works
Phongkhun, K., Pothikamjorn, T. L., Srisurapanont, K., Manothummetha, K., Sanguankeo, A., Thongkam, A., Chuleerarux, N., Leksuwankun, S., Meejun, T., Thanakitcharu, J., et al. (2023) · Clinical Infectious Diseases · doi:10.1093/cid/ciad064 · Cited by 47 · see citing works
Endogenous Fungal Endophthalmitis: Causative Organisms, Treatments, and Visual Outcomes
Chen, K., Sun, M., Chen, Y., Chen, Y., Wang, N., Liu, L., Chao, A., Wu, W., Hwang, Y., & Lai, C. (2022) · Journal of Fungi · doi:10.3390/jof8060641 · Cited by 23 · see citing works
Screening for Ocular Candidiasis Among Patients With Candidemia: Is It Time to Change Practice?
O’Donnell, M., Eller, A. W., Waxman, E. L., Clancy, C. J., & Nguyen, M. H. (2022) · Clinical Infectious Diseases · doi:10.1093/cid/ciac233 · Cited by 20 · see citing works
Singh, S., Singh, S., & Kumar, A. (2022) · Microbiology Spectrum · doi:10.1128/spectrum.01658-22 · Cited by 20 · see citing works
Zhang, W.-F., Zhao, X., Chen, H., Meng, L., & Chen, Y. (2023) · Ocular Immunology and Inflammation · doi:10.1080/09273948.2023.2198001 · Cited by 10 · see citing works
Candida Endophthalmitis Treated Successfully With Isavuconazole: A Case Report
Sng, E. C. Y., Tan, A. L., Zhou, P. Y., Tan, T. J., Waduthantri, S., Chee, S.-P., & Tan, B. H. (2021) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofab516 · Cited by 9 · see citing works
Fekri, S., Khorshidifar, M., Esfahanian, F., Veisi, A., Nouri, H., & Abtahi, S.-H. (2023) · Journal Français d Ophtalmologie · doi:10.1016/j.jfo.2022.12.002 · Cited by 7 · see citing works
Gentile, P., Ragusa, E., Bruno, R., Ceccarelli, F., Adani, C., Bolletta, E., Simone, L. D., Gozzi, F., & Cimino, L. (2025) · Ocular Immunology and Inflammation · doi:10.1080/09273948.2025.2524013 · Cited by 6 · see citing works
Diagnosis and management of Candida endophthalmitis and chorioretinitis
Permpalung, N., Sedik, S., Pappas, P. G., Hoenigl, M., & Ostrosky‐Zeichner, L. (2025) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2025.05.028 · Cited by 4 · see citing works
Risk factors for endogenous endophthalmitis in infectious endocarditis patients
Shah, M., Zhu, A., Uppuluri, A., Henry, R. K., Zarbin, M. A., & Bhagat, N. (2024) · Eye · doi:10.1038/s41433-024-03390-w · Cited by 4 · see citing works
Dellai, F., Pagotto, A., Sbrana, F., Ripoli, A., Danieli, G., Colombo, A. E., D’Elia, D., Geminiani, M., Giuliano, S., Sartor, A., et al. (2025) · Journal of Fungi · doi:10.3390/jof11050400 · Cited by 3 · see citing works
Tehrani, S., Fekri, S., Demirci, H., Nourizadeh, A. M., Kashefizadeh, A., Shahrbaf, M. A., Keyvanfar, A., & Nejad, F. M. (2023) · Ocular Immunology and Inflammation · doi:10.1080/09273948.2023.2188224 · Cited by 3 · see citing works
Zhang, W., Zhao, X., Chen, H., Meng, L., & Chen, Y. (2022) · Research Square · doi:10.21203/rs.3.rs-2195545/v1 · Cited by 3 · see citing works
Collins, F., Wenlock, R. D., Curtis, S., Hyde, J., & James, P. R. (2021) · Clinical Infection in Practice · doi:10.1016/j.clinpr.2021.100106 · Cited by 2 · see citing works
Sugisawa, T., Ishikawa, H., Uchida, K., Takesue, Y., Mori, J., Kinoshita, T., Morikawa, S., Okamoto, F., Sawada, T., Ohji, M., et al. (2022) · Ocular Immunology and Inflammation · doi:10.1080/09273948.2022.2112237 · Cited by 2 · see citing works
Pek, Z., & Bork, J. T. (2023) · Current Fungal Infection Reports · doi:10.1007/s12281-023-00468-y · Cited by 1 · see citing works
Candidemia treatment is improved by infectious disease consultation: A population-based cohort study
Bourassa‐Blanchette, S., Biesheuvel, M. M., Lam, J. C., Kipp, A. J., Church, D. L., Carson, J. A., Dalton, B., Parkins, M. D., Barkema, H. W., & Gregson, D. B. (2024) · Journal of the Association of Medical Microbiology and Infectious Disease Canada · doi:10.3138/jammi-2024-0001 · Cited by 1 · see citing works
Akazawa, H., Fukushima, S., Higuchi, T., Miyoshi, T., Nakano, Y., Iio, K., Akamatsu, Y., Haruki, Y., Iwamoto, Y., Tanaka, S., et al. (2025) · Mycopathologia · doi:10.1007/s11046-025-00999-7 · Cited by 1 · see citing works
Akazawa, H., Fukushima, S., Higuchi, T., Miyoshi, T., Nakano, Y., Iio, K., Akamatsu, Y., Haruki, Y., Iwamoto, Y., Tanaka, S., et al. (2025) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofaf790 · Cited by 1 · see citing works
Endogenous Candida endophthalmitis: Has it been discerned from a cotton wool spot in the retina?
Breazzano, M. P. (2021) · Journal of Infection · doi:10.1016/j.jinf.2021.09.011 · Cited by 1 · see citing works
Tatara, A. M. (2023) · Springer eBooks · doi:10.1007/978-3-031-39474-4_5
Cao, X., Jia, P., Zhao, L., Qiao, X., Duan, Y., Jia, J., & Xin, J. (2025) · Infection and Drug Resistance · doi:10.2147/idr.s497721
Canouï, É., Lez, M. L., & Dedieu, D. (2025) · Médecine et Maladies Infectieuses Formation · doi:10.1016/j.mmifmc.2025.06.003
Miyase, T., Mochizuki, K., Kawakami, H., Yonetamari, J., Inuzuka, M., Sakai, S., Suemori, S., Baba, H., & Sakaguchi, H. (2025) · Japanese Journal of Ophthalmology · doi:10.1007/s10384-025-01269-1
- Authors
- Seidelman, J., Fleece, M., Bloom, A., Lydon, E., Yang, W., Arnold, C., Weber, D. J., & Okeke, N. L.
- Affiliations
- Duke University (US)
- University of Virginia (US)
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Seidelman, Jessica
- Okeke, Nwora Lance
- ORCID
- Venue
- Journal of Infection
- Publisher
- Elsevier BV
- Published
- 2021-02
- Volume
- 82
- Issue
- 2
- Pages
- 276-281
- ISSN
- 0163-4453 (ISSN-L)
- OpenAlex
- W3120601118
- Cited by
- 26
- References
- 32
- Citations by year
- 2025: 8 · 2024: 2 · 2023: 7 · 2022: 5 · 2021: 4
- FWCI
- 4.06
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Journal of Infection (publishedVersion)
- PubMed (publishedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Topics
- Health Sciences › Medicine › Ophthalmology › Ocular Infections and Treatments
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Keywords
- candidemia, risk factors, central venous catheters, intravenous drug use, immunosuppression, total parenteral nutrition, Candida albicans, retinal examination
- MeSH terms
- Candida, Candidiasis, Humans, Endophthalmitis, Retrospective Studies, Risk Factors, Eye Infections, Fungal
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
