Abstract
Purpose :
To analyze risk factors for endogenous endophthalmitis and ophthalmology consults in a tertiary care inpatient setting.
Methods :
Inpatient encounters at Stanford Hospital between 2010-2014 from patients who A) had positive fungal cultures from any source, B) received IV antifungals, or C) had positive bacterial blood cultures and received IV antibacterials were identified using STRIDE (Stanford Translational Research Integrated Database Environment). STRIDE is a research and development project at Stanford University to create a standards-based informatics platform supporting clinical and translational research. Patient encounters with an endophthalmitis ICD-9 code were identified and manually reviewed for accuracy. Encounter characteristics including length of hospital stay, gender, and presence of an ophthalmology or infectious disease (ID) consult note were also identified. Logistic regression was performed using SAS Enterprise Guide Version 6.1.
Results :
We identified 7131 patient encounters meeting the above criteria for fungal or bacterial infection; 290 of these patients had an ophthalmology consult during their admission. Presence of an infectious disease consult (OR 9.73, 95% CI 7.17-13.40), fungal culture from any source (OR 3.59, 95% CI 2.70-4.78), and IV antifungal use (OR 1.91, 95% CI 1.43-2.55) were most predictive of ophthalmology consultation. Each additional 10 days of admission was associated with a 12% increase in odds of ophthalmology consultation (OR 1.12, 95% CI 1.08-1.17). Twenty-two identified encounters (15 fungal and 7 bacterial) had a positive endophthalmitis diagnosis (0.3% incidence). Infectious disease consults (OR 3.80, 95% CI 1.54-9.34) and positive fungal cultures (OR 5.08, 95% CI 1.69-15.29) were most associated with endophthalmitis. Length of stay, age, sex, use of IV antifungals, or signs of bacterial infection were not significantly predictive of endophthalmitis.
Conclusions :
We identified a 0.3% incidence of endophthalmitis among patients with bacteremia or fungal infection. Fungal infection and infectious disease consults were most predictive of ophthalmology consults, and positive fungal cultures or infectious disease consultations were significantly associated with an endophthalmitis diagnosis. Further analyses are indicated to better predict positive findings and identify appropriate patients for consultation.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.