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Volume 20, Number 2—February 2014

Research

Fungal Endophthalmitis Associated with Compounded Products

Christina A. Mikosz1, Rachel M. Smith1, Moon Kim, Clara Tyson, Ellen H. Lee, Eleanor Adams, Susanne Straif-Bourgeois, Rick Sowadsky, Shannon Arroyo, Yoran Grant-Greene, Julie Duran, Yvonne Vasquez, Byron F. Robinson, Julie R. Harris, Shawn R. Lockhart, Thomas J. Török, Laurene Mascola, Benjamin J. ParkComments to Author , and for the Fungal Endophthalmitis Outbreak Response Team
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.A. Mikosz, R.M. Smith, Y. Grant-Greene, B.F. Robinson, J.R. Harris, S.R. Lockhart, T.J. Török, and B.J. Park); Los Angeles County Department of Public Health, Los Angeles, California, USA (C.A. Mikosz, M. Kim, C. Tyson, and L. Mascola); New York City Department of Health and Mental Hygiene, New York City, New York, USA (E.H. Lee); New York State Department of Health, Albany, New York, USA (E. Adams); Louisiana Office of Public Health, New Orleans, Louisiana, USA (S. Straif-Bourgeois); Nevada Division of Public and Behavioral Health, Carson City, Nevada, USA (R. Sowadsky); Indiana State Department of Health, Indianapolis, Indiana, USA (S.Arroyo); Illinois Department of Public Health, Springfield, Illinois, USA (Y. Grant-Greene); Colorado Department of Public Health and Environment, Denver, Colorado, USA (J. Duran); City of El Paso Department of Public Health, El Paso, Texas, USA (Y. Vasquez)

Main Article

Table 1

Case–control results for species-confirmed fungal endophthalmitis cases, United States, 2012*

Variable Fusarium spp. cluster
Bipolaris spp. cluster
Case-patients, no. (%), n = 6 Controls, no. (%), n = 18 mOR (95% CI) Case-patients, no. (%), n = 7 Controls, no. (%), n = 18 mOR (95% CI)
Patient characteristic
Female sex 5 (83) 4 (22) 12.0 (0.99–472.73), p = 0.05 3 (43) 11 (61) 0.61 (0.05–5.71), p = 0.94
Diabetes 3 (50) 7 (39) 1.50 (0.18–11.43), p = 0.98 6 (86) 4 (22) 13.33 
(1.12–492.51), p = 0.04
Hypertension 3 (50) 7 (39) 1.40 (0.15–24.76), p>0.99 7 (100) 15 (83) Undef (0.33–∞), p = 0.50
History of eye surgery or procedures
4 (67)
12 (67)
1.00 (0.11–12.77), p>0.99

4 (57)
16 (89)
0.25 
(0.003–2.440), p = 0.28
Medications received
Cyclopentolate 4 (67) 15 (83) 0 (0–6.33), p = 0.50 0 0 NC
Phenylephrine 3 (50) 15 (83) 0 (0–1.16), p = 0.13 0 0 NC
Tropicamide 0 0 NC 0 0 NC
Bupivacaine 0 4 (22) 0 (0–3.47), p = 0.50 0 0 NC
Atropine 0 4 (22) 0 (0–3.00), p = 0.38 0 0 NC
Lidocaine 1 (17) 7 (39) 0.20 (0.005–4.32), p = 0.59 2 (29) 5 (28) 1.00 (0.008–130.300), p>0.99
Tetracaine 2 (33) 10 (56) 0 (0–3.40), p = 0.56 3 (43) 3 (17) Undef (0.16–∞), p = 0.50
Brilliant blue G dye† 6 (100) 2 (11) Undef (3.47–∞), p = 0.002 0 0 NC
Cefazolin 0 1 (6) 0 (0–57.00), p>0.99 0 0 NC
Antimicrobial ophthalmic ointment 0 3 (17) 0 (0–5.81), p = 0.75 1 (14) 0 Undef (0.16–∞), p = 0.50
Vancomycin 2 (33) 6 (33) 1.00 (0.06–16.26), p>0.99 0 0 NC
Moxifloxacin 4 (67) 11 (61) 1.50 (0.07–91.71), p>0.99 0 3 (17) 0 (0–3.87), p = 0.50
Triamcinolone† 0 0 NC 7 (100) 2 (11) Undef (3.68–∞), p = 0.001
Bevacizumab 0 0 NC 5 (71) 14 (78) 1.00 (0.008–130.30), p>0.99
Dexamethasone 0 3 (17) 0 (0–5.14), p = 0.84 0 10 (56) 0 (0–0.52), p = 0.02

*mOR, median odds ratio; Undef, undefined; NC, not calculated.
†Manufactured by Franck’s Compounding Lab, Ocala, Florida, USA.

Main Article

1These authors contributed equally to this article and are co–first authors.

2Members of the Fungal Endophthalmitis Outbreak Response Team are listed at the end of this article.

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