Objectives Ocular candidiasis (OC) can complicate Candida bloodstream infection (BSI). Antifungal treatment improves the prognosis of patients with BSI, but the effects of choice and timing of first-line medication on OC risk are incompletely understood. We explored the early treatments, risk factors and ocular presentations in Candida BSI. Methods and analysis All patients (n=304) with Candida BSI during 2008–2017 at Oulu University Hospital were included. Those patients in whom clinical condition was appropriate for ocular examination (OE), including biomicroscopy (n=103), were carefully analysed by ophthalmologists. Criteria for patient selection were considered. Candida and yeast species, antifungal medications, echocardiography, underlying diseases and clinical properties of the patients with Candida BSI were analysed. Results Clinical condition in 103 patients had been considered appropriate for OE. OC was diagnosed in 33 of the 103 patients. Candida albicans was the most common finding (88%) in OC. Patients in intensive care, alcohol-related conditions or poor prognosis were less frequently examined. Persistent candidemia increased the risk of OC. Chorioretinitis and endophthalmitis were diagnosed in 94% and 48% of the patients with OC, respectively. Any early antifungal treatment decreased the endophthalmitis risk. Echinocandin lowered the OC risk in those with central venous catheters (CVCs) or abdominal malignancy. Conclusion Critical condition of patients with Candida BSI affects the selection and results of OE. OC was associated with C. albicans BSI especially among those with persistent candidemia, CVC or abdominal malignancy. Any early antifungal treatment reduced endophthalmitis risk. Early echinocandin treatment may reduce the risk of OC in selected patients. Data are available upon reasonable request. Available upon request.

中文翻译：

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一线抗真菌治疗对念珠菌或酵母菌血流感染眼部并发症风险的影响

目的 眼念珠菌病 (OC) 可使念珠菌血流感染 (BSI) 复杂化。抗真菌治疗可改善 BSI 患者的预后，但一线药物的选择和时机对 OC 风险的影响尚不完全清楚。我们探讨了念珠菌 BSI 的早期治疗、危险因素和眼部表现。方法与分析 包括 2008-2017 年在奥卢大学医院的所有念珠菌 BSI 患者（n=304）。眼科医生仔细分析了临床状况适合进行眼科检查 (OE) 的患者，包括生物显微镜检查 (n=103)。考虑了患者选择的标准。分析了念珠菌和酵母菌种类、抗真菌药物、超声心动图、基础疾病和念珠菌BSI患者的临床特征。结果 103 例患者的临床状况被认为适合 OE。103 名患者中有 33 名被诊断为 OC。白色念珠菌是 OC 中最常见的发现 (88%)。重症监护、酒精相关疾病或预后不良的患者检查频率较低。持续的念珠菌血症增加了 OC 的风险。分别有 94% 和 48% 的 OC 患者诊断出脉络膜视网膜炎和眼内炎。任何早期的抗真菌治疗都会降低眼内炎的风险。棘白菌素降低了中心静脉导管 (CVC) 或腹部恶性肿瘤患者的 OC 风险。结论 念珠菌BSI患者病情危重影响OE的选择和结果。OC 与白色念珠菌 BSI 相关，尤其是在持续念珠菌血症、CVC 或腹部恶性肿瘤的患者中。任何早期的抗真菌治疗都会降低眼内炎的风险。早期棘白菌素治疗可降低选定患者发生 OC 的风险。可根据合理要求提供数据。可应要求提供。