Identifying novel risk factors for ocular lesions in patients with fungemia and determining the efficacy of routine screening.

Purpose: To identify novel risk factors associated with the presence of fungal ocular lesions in patients with fungemia and to evaluate the validity and efficacy of routine screening.

Study Design: Retrospective study METHODS: The medical records of 198 patients diagnosed with fungemia by blood culture at 3 medical centers in Japan between March 2017 and April 2022 were analyzed. Ocular lesions were categorized as possible, probable, or proven, according to previously established definitions. The primary outcome measure was prevalence of ocular lesions. Secondary outcomes included the classification of ocular lesions and mortality.

Results: Among the 198 patients with fungemia, 115 underwent fundus examination. Ocular lesions were observed in 40 patients (34.8%), with 16 classified as probable and 24 as possible. Among those with positive ocular lesions, 5 (12.5%) complained of ocular symptoms, whereas 21 (52.5%) had impaired consciousness. Impaired consciousness was associated with an increased prevalence of ocular lesions (odds ratio [OR], 2.70). Bedside ophthalmic consultations were associated with the classification of ocular lesions (OR, 0.0485). Positive ocular lesions and echinocandin administration were associated with mortality (ORs, 3.180 and 4.140, respectively).

Conclusion: Our study results demonstrate that impaired consciousness is an independent risk factor for ocular lesions. Moreover, the presence of ocular lesions was determined to be an independent factor associated with mortality, highlighting the importance of detecting these lesions in systemic management. Based on these findings, we recommend dilated fundus examination by ophthalmologists in patients with fungemia who do not complain of visual symptoms.