Which type of bacteremia is compulsory for endophthalmitis screening in patients with a history of recent ocular surgery, trauma, or injection drug use, particularly those who are immunocompromised?

Candidemia Requires Mandatory Endophthalmitis Screening

All patients with candidemia must undergo dilated fundoscopic examination by an ophthalmologist within the first week of antifungal therapy to screen for endophthalmitis. 1, 2

Bacteremia Types Requiring Screening

Mandatory Screening

• Candidemia: The Infectious Diseases Society of America explicitly recommends dilated retinal examination within the first week of therapy for all candidemia patients, as Candida can seed the eye hematogenously across the blood-eye barrier 1, 2
• Candida albicans is the most common causative organism in fungal endophthalmitis among hospitalized patients with candidemia 1, 3

High-Risk Bacteremia Requiring Clinical Judgment

While not explicitly "compulsory" by guidelines, the following bacteremias warrant strong consideration for screening based on risk factors:

• Staphylococcus aureus bacteremia with endocarditis: S. aureus is an important cause of endogenous endophthalmitis associated with endocarditis 4
• Streptococcal bacteremia with endocarditis: Streptococci are important causes of endogenous endophthalmitis in endocarditis patients 4
• Klebsiella pneumoniae bacteremia with liver abscess: In East Asian populations, K. pneumoniae causes most cases of endogenous endophthalmitis in association with liver abscess 4

Additional High-Risk Populations Requiring Screening

Beyond specific bacteremia types, screening should be performed for:

• Injection drug users with any bacteremia, as hematogenous dissemination is a recognized risk factor for endophthalmitis 5, 1
• Immunocompromised patients with disseminated aspergillosis, as Aspergillus can cause endophthalmitis via hematogenous spread 5, 1

Screening Method

• Direct dilated fundoscopic examination by an ophthalmologist is the required screening approach 6, 1
• If endophthalmitis is suspected clinically, obtain vitreous or aqueous humor culture via diagnostic tap before initiating treatment 6, 1

Critical Pitfall

Do not dismiss the need for ophthalmologic screening in candidemia patients even if they are asymptomatic, as endogenous Candida endophthalmitis can develop during the course of candidemia and early detection is essential for preserving vision 2, 3