Incidence of Drug Use–Related Endogenous Endophthalmitis Hospitalizations in the United States, 2003 to 2016

Abstract

IMPORTANCEComplications arising from the nationwide opioid epidemic led to an increase in health care use. Few studies have investigated whether this is reflected in hospital admissions for endogenous endophthalmitis. OBJECTIVE To report changing trends in epidemiology, risk factors, hospital course, and costs associated with drug use-related endogenous endophthalmitis hospitalizations in the United States from 2003 to 2016. DESIGN, SETTING, AND PARTICIPANTS Nationwide, retrospective cross-sectional study using the National Inpatient Sample. A total of 56 839 patients admitted with a diagnosis of endogenous endophthalmitis were included. Data were analyzed between 2003 and 2016. EXPOSURES Inpatient admission for endogenous endophthalmitis during the years 2003 to 2016. MAIN OUTCOMES AND MEASURESThe Nationwide Inpatient Sample was queried to identify all inpatient admissions with a diagnosis of endogenous endophthalmitis in the United States between the years 2003 and 2016. Analyses were performed to identify national and regional trends in incidence and prevalence of associated infectious and noninfectious comorbidities in patients with or without a history of drug dependence or use. Median and cumulative inflation-adjusted costs for admissions were calculated.RESULTS Of all patients, 55.6% were White, 13.6% were Black, and 10.6% were Hispanic. There were an estimated 56 839 endogenous endophthalmitis-related hospitalizations; 13.7% of these patients (n = 7783) had a history of drug dependence or use. The drug-using population was significantly younger (49.6 vs 57.5 years; difference, 7.9; 95% CI, 6.93-8.88; P < .001) and more likely to be male (61.8% [n = 35 127] vs 49.0% [n = 21 712]; difference, 12.8%; 95% CI, 11.6%-14.0%; P < .001). The incidence of endogenous endophthalmitis associated with drug dependence or use increased from 0.08 per 100 000 in 2003 to 0.32 per 100 000 population in 2016 across all 4 US geographic regions.CONCLUSIONS AND RELEVANCE A 4-fold increase in drug use-related endogenous endophthalmitis hospitalizations was observed in the United States from 2003 to 2016, resulting in substantial health care use burden. These findings support the hypothesis that clinicians should maintain a high index of suspicion for endophthalmitis when evaluating patients with intraocular inflammation in the setting of drug dependence or use.

Endogenous Fungal Endophthalmitis: Causative Organisms, Treatments, and Visual Outcomes

“…As reported in the literature [ 17 , 18 , 19 , 20 ], patients with a history of IVDU exhibit a higher risk of EFE because of the direct inoculation of pathogens into the bloodstream. Mir et al [ 21 ] reviewed 56,839 cases of endogenous endophthalmitis hospitalizations in the United States and reported that 13.7% had a history of IVDU. In a previous study, 9.8% and 1.8% of patients with IVDU had a diagnosis of Candida infection and disseminated candidiasis, respectively [ 21 ].…”

“…Mir et al [ 21 ] reviewed 56,839 cases of endogenous endophthalmitis hospitalizations in the United States and reported that 13.7% had a history of IVDU. In a previous study, 9.8% and 1.8% of patients with IVDU had a diagnosis of Candida infection and disseminated candidiasis, respectively [ 21 ]. However, no statistical difference in Aspergillus infection was observed between patients with IVDU and patients without IVDU.…”

Fungal Endophthalmitis: A Comprehensive Review

“…An important contributing cause of endogenous endophthalmitis is intravenous drug use: Mir et al reviewed 56,839 cases of endogenous endophthalmitis hospitalizations in the United States and found that 13.7% had a history of drug dependence or use. If these, 9.8% had Candida infection and 1.8% had disseminated candidiasis [53]. Furthermore, the incidence of endogenous endophthalmitis associated with drug dependence or use has increased from 0.08 per 100,000 people in 2003 to 0.32 per 100,000 people in 2016 [53].…”

Opioid Prescribing Patterns of Optometrists in the Medicare Part D Database

“…To date, there has been no investigation into the pattern of opioid prescribing by optometrists. Previous studies examining the opioid prescribing rates of eye care providers have focused on the amount of general opioid prescriptions written by ophthalmologists 8–15 . The role of the optometrist prescribing opioids is relevant not only for analysis of clinical practice patterns for primary eye care, but with the trend of co-managed surgical patients, optometrists are often co-managing post-operative surgical patients 24 to 36 hours after surgery 16 .…”

“…Previous studies examining the opioid prescribing rates of eye care providers have focused on the amount of general opioid prescriptions written by ophthalmologists. [8][9][10][11][12][13][14][15] The role of the optometrist prescribing opioids is relevant not only for analysis of clinical practice patterns for primary eye care, but with the trend of co-managed surgical patients, optometrists are often co-managing post-operative surgical patients 24 to 36 hours after surgery. 16 The purpose of this study is to examine the prescription rates and prescribing trends of opioids by optometrists listed in the Centers for Medicare & Medicaid Services (CMS) part D database.…”