Species-specific risk of ophthalmic involvement in candidaemia: a propensity-matched competing risk analysis.

Objectives: Given the limited data on species-specific ocular involvement in candidaemia, we aimed to assess the differential risk of ocular involvement according to Candida species in patients with candidaemia.

Methods: A retrospective review was conducted of patients with candidaemia who underwent funduscopic examination at a tertiary centre in Seoul, Republic of Korea between January 2014 and December 2023. Ocular involvement, defined as endophthalmitis, was determined by two retinal specialists. Propensity score matching and competing risk analyses were performed to adjust for pre-specified risk factors and mitigate competing risk bias.

Results: A total of 674 patients with candidaemia were included. Endophthalmitis was identified in 5% (32/674), and probable chorioretinitis in 10% (67/674). The prevalence of endophthalmitis was relatively high in Candida albicans (16/245, 7%) and C. tropicalis (13/126, 10%), but low in C. glabrata (0/193), C. parapsilosis (2/68, 3%), and C. krusei (0/19). Competing risk analysis identified C. albicans or C. tropicalis infection (subdistribution hazard ratio [sHR] 7.90, 95% CI: 2.42-25.75) as an independent risk factor for endophthalmitis. In propensity score-matched analyses, C. albicans (sHR 5.85, 95% CI: 1.71-19.95) and C. tropicalis (sHR 6.97, 95% CI: 1.58-29.85) were each significantly more associated with ocular involvement than non-albicans and non-tropicalis species.

Discussion: Although ophthalmic examinations are already recommended in all candidaemia cases, our findings underscore their particular importance in C. albicans and C. tropicalis infections, where ocular involvement is significantly more common than in those involving other Candida species.