Bacterial or fungal co-infection and endogenous endophthalmitis in hospitalized patients with coronavirus disease 2019

Purpose : Coronavirus disease 2019 (COVID-19) is a pandemic viral illness which may predispose to co-infections and whose ophthalmic manifestations are still not well understood. This study was performed to determine the rate of bacterial or fungal coinfection and associated endogenous endophthalmitis in inpatients with COVID-19. Methods : This was a retrospective cohort study of inpatients with COVID-19-associated pneumonia at seven general hospitals in Louisville, Kentucky from March to May 2020. All patients were positive by polymerase chain reaction for SARS-CoV-2 and had clinical evidence of pneumonia necessitating hospital admission. Records were reviewed for demographic data, clinical evidence of systemic bacterial or fungal co-infection, culture results, and evidence of endophthalmitis. Results : There were 632 patients in this study. Median age was 63 (IQR 48-74), and 53% were female. 65 of them (10.3%) had a systemic, culture-positive bacterial or fungal coinfection (60 bacterial, 5 fungal). Of these 65 patients, 11 developed bacteremia (16.9% of co-infected patients;1.7% of all COVID inpatients). One patient with Streptococcal bacteremia and septic arthritis developed endogenous endophthalmitis in one eye (1/65 co-infected patients, 1.5%;1/632 total COVID inpatients, 0.16%), which was successfully treated with intravitreal antibiotics. No patients with negative blood cultures developed endophthalmitis, although the sole endophthalmitis patient presented with intraocular infection prior to blood cultures being positive. Conclusions : Bacterial or fungal co-infection is relatively common in inpatients with COVID-19. Endogenous bacterial endophthalmitis, while rare, is still a possible and potentially devastating complication of the disease. Consequently, visual complaints in COVID-19 inpatients should be assessed promptly.