Outcomes with Endogenous Endophthalmitis from Candidal versus Bacterial Sepsis

To compare one-year ophthalmic outcomes in endogenous endophthalmitis following candidal versus bacterial sepsis using a large, multicenter electronic health record database.

Retrospective propensity score-matched cohort study with a global, federated database.

Patients in the TriNetX Analytics Network diagnosed with endophthalmitis and antecedent candidal or bacterial sepsis within 7 days were identified.

Patients were matched 1:1 by propensity score for age, sex, race, ethnicity, type 2 diabetes mellitus, human immunodeficiency virus infection, malignant neoplasms, liver disease, and transplanted organ or tissue status.

One-year relative risk (RR) of incident retinal detachment, vitreoretinal intervention, and all-cause mortality. A secondary analysis assessed composite vision or globe loss without exclusion of prior diagnosis. The number of intravitreal injections administered was also compared between cohorts.

In total, 318 candidal and 1,173 bacterial sepsis patients with endophthalmitis were identified. After matching, each cohort included 304 patients with well-balanced baseline characteristics. Compared with bacterial sepsis, candidal sepsis was associated with significantly lower rates of retinal detachment (3.8% vs. 7.8%; RR 0.49, 95% CI 0.24-0.99), vitreoretinal intervention (4.1% vs. 14.2%; RR 0.29, 95% CI 0.15-0.53), and composite vision and globe loss in the secondary analysis (4.3% vs. 26.6%; RR 0.16, 95% CI 0.09-0.28). The mean number of intravitreal injections administered per patient did not significantly differ between cohorts (mean±SD 2.25±4.03 candidal vs. 1.23±0.65 bacterial; P=.209). One-year mortality was significantly higher with candidal sepsis (35.4% vs. 25.3%; RR 1.40, 95% CI 1.09-1.79; p=.007).

In this large-scale, propensity-matched analysis, candidal sepsis was associated with significantly lower rates of retinal detachment and vitreoretinal intervention compared with bacterial sepsis, despite higher all-cause mortality. These divergent findings indicate that endogenous Candida endophthalmitis, despite its greater systemic morbidity, may carry lower ophthalmic risk than bacterial disease. Multicenter, prospective studies with visual acuity data are needed to further characterize pathogen-specific differences in ophthalmic risk.