Abstract
Purpose :
The current opioid crisis has led to a dramatic increase in infectious complications associated with injection drug use (IDU) including endophthalmitis. The frequency of endophthalmitis, the spectrum of lesions, and the microbiology of infectious chorioretinitis in this population are poorly characterized. We hypothesize that patients with bacteremia related to IDU will have ocular involvement.
Methods :
This is a prospective study that enrolled patients 18 years and older, admitted to Wake Forest Baptist Medical Center with documented bloodstream infections related to IDU. After enrollment in the study, a dilated retinal exam was performed within 72 hours. Ocular symptoms, visual acuity, and ocular exam findings were documented, and fundus photos were obtained when necessary or to document lesions.
Results :
37 patients were identified with bacteremia related to IDU. Average age was 33 years old (range 20-65) and 51% were male and 49% were female. 8% of the patients had ocular symptoms at the time of examination. 16% (6/37) of patients were found to have ocular involvement on examination, and of the patients with ocular involvement, 33% (2/6) were symptomatic. 5% (2/37) had retinal findings possibly related to prior infection (multifocal chorioretinal scarring in distribution of metastatic foci of infection). The organisms involved in the cases were: an isolated Candida albicans endophthalmitis in which the patient was symptomatic; MRSA with infectious endocarditis and septic pulmonary emboli causing a subretinal infiltrate with hemorrhage; MSSA endocarditis and sepsis leading to multiple white subretinal lesions and hemorrhage; streptococcus mitis/oralis endocarditis causing cotton wool spots (CWS) and hemorrhages; MRSA with a right renal abscess and brow abscess; and streptococcus pyogenes with an abscess of the right sternoclavicular joint and thrombosis of the right brachial vein leading to an infiltrate and CWS.
Conclusions :
Our results are consistent with our hypothesis that asymptomatic patients admitted with infectious bacteremia following IDU will have ophthalmic involvement. Further study is needed to better characterize the epidemiology of these infections and to identify risk factors for ocular involvement in this patient population.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.