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Devon Ghodasra, Kian Eftekhari, Ankoor R Shah, Brian L VanderBeek; Utility and costs of ophthalmic consultation for fungemia. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2850.
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Currently, ophthalmologic consultation is recommended for all inpatients with fungemia. These patients, however, are often critically ill and have a high mortality rate. In addition, with earlier detection and antifungal use the rate of ocular involvement may be decreasing. The purpose of this study is to determine the utility and associated costs of inpatient ophthalmic consultation for fungemic patients.
A retrospective case series of all adult patients with positive fungal blood cultures at the Hospital of the University of Pennsylvania from 2008-2012.
36 of 474 (7.6%) of eyes and 22 of 239 patients (9.2%) had fungal eye involvement. The most common organism identified were Candida albicans (45.6%) and Candida parapsilosis(13.8%).Of these, management was changed in only 9 patients(8 medication changes/1 antifungal intravitreal injection/0 vitrectomies). 39.1% of patients without eye involvement and 31.8% with eye involvement died before discharge or were discharged to hospice.The mortality rate was higher for fungemic patients too sick for eye examination(66/110, 60% vs. 69/239 (28.9%) for those without a consult). The cost of new consults was $91,537 (239 visits at $383/visit). The cost of follow-up visits was $22,880 (130 visits at $176/visit). The total cost per patient who had their management changed was $12,713/patient. Since only 1 patient required an intravitreal injection, the cost to find that one patient was $114,417.
Ocular involvement was present in 9% of patients with fungemia and an even lower incidence of cases in which the ophthalmic examination changed management. These rates are even lower once the high mortality rate is factored in. Our results suggest that routine ophthalmic examination of patients with fungemia without other ocular signs may not be cost-effective.
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