Vitreous and Chorioretinal Lesions in People Who Inject Drugs Hospitalized with Bloodstream and Related Infections.

Abstract: Purpose To determine the prevalence of and characterize vitreous and chorioretinal lesions, identify causative organisms, and correlate symptoms with ophthalmic involvement in people who inject drugs (PWID) hospitalized with bloodstream infection (BSI) and/or related metastatic foci of infection (MFI). Design An academic hospital-based cross-sectional study Participants Patients admitted with BSI or MFI related to injection drug use (IDU) Methods Subjects received a complete eye exam within 72 hours of enrollment. Characteristics including gender, age, race, injection drug of choice (DOC), presence of co-infection with hepatitis B, hepatitis C or HIV, pathogen causing systemic infection and type of infection, and history of prior infection related to IDU were recorded. Main outcome measures Presence of vitreous and/or chorioretinal findings. Results Ninety-one unique patients with 96 separate hospitalizations for systemic infection were enrolled from 3/28/2018 to 3/30/2020. Vitreous or chorioretinal involvement was identified in 16/96 (16.7%). The most common ocular findings were intraretinal or white-centered hemorrhage (IRH) in 9/96, chorioretinal infiltrate in 8/96, endophthalmitis in 5/96, and cotton wool spots (CWS) in 3/96. Of the patients with ocular involvement, only 7/16 (44%) were symptomatic, and 5 of these were patients with endophthalmitis; the others had chorioretinal infiltrates or IRH and CWS. Staphylococcus aureus was the most common causative pathogen in patients with and without ocular findings. Presence of ocular symptoms, worse visual acuity and DOC of methamphetamine were correlated with the presence of ocular findings. Conclusion Patients without ocular symptoms with systemic infections related to IDU may have chorioretinal findings. Further study is needed to better characterize the epidemiology of these infections and to identify risk factors for ocular involvement in PWID.