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National emergency department trends for endogenous endophthalmitis: an increasing public health challenge



To characterize incidence rates and identify risk factors for admission and mortality in patients with endogenous endophthalmitis (EE) in the United States (US).


Patients with EE were identified using the Nationwide Emergency Department (NEDS) Database from 2006 to 2017 in this cross-sectional study. Subjects were required to have diagnoses of both endophthalmitis and septicaemia using contemporary International Classification of Diseases diagnosis codes. Incidence rates, mortality rates and demographics were evaluated. Risk factors for admission and mortality were identified using weighted logistic regression analysis.


A total of 6400 patients with EE were identified. Incidence increased from 0.10 (95% confidence interval [CI]: 0.07–0.12) per 100,000 in the US population in 2006 to 0.25 (95% CI: 0.21–0.30) in 2017 (p < 0.05). Most were female (55.4%), insured with Medicare (53.5%), were in the first income quartile earnings (29.3%) [bottom 25% income bracket], lived in the South (40.5%), and presented to metropolitan teaching hospitals (66.6%). Mortality increased from 8.6% (95% CI: 3.8–18.3%) in 2006 to 13.8% (95% CI: 9.7–19.2%) in 2017 (p = 0.94). Factors predicting admission included older age (odds ratio [OR] 32.59; [95% CI 2.95–359.78]) and intravenous drug use (OR 14.90 [95% CI: 1.67–133.16]). Factors associated with increased mortality included: human immunodeficiency virus infection/immune deficiencies (OR 2.58 [95% CI: 1.26–5.28]), heart failure (OR 2.12 [95% CI: 1.47–3.05]), and hepatic infections/cirrhosis (OR 1.89 [95% CI: 1.28–2.79]). Pneumonia and renal/urinary tract infections (UTI) were associated with both increased hospital admission [(pneumonia OR 9.64 (95% CI: 1.25–74.35, p = 0.030), renal/UTI OR 4.09 (95% CI: 1.77–9.48)] and mortality [(pneumonia OR 1.64 (95% CI: 1.17–2.29, p = 0.030), renal/UTI OR 1.87 (95% CI: 1.18–2.97)]. Patients with diabetes mellitus (DM) had decreased odds ratio for mortality (OR 0.49 [95% CI: 0.33–0.73]).


EE has increased in incidence throughout US. The two systemic factors that conferred both an increase in mortality and admission were pneumonia, and renal/UTI. Additional exploration of the potential protective association of DM with decreased mortality in this context is needed.

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Fig. 1: Incidence rates of emergency department visits for endogenous endophthalmitis.
Fig. 2: Median inflation-adjusted cost of ED visits.

Data availability

The data that support the findings of this study are available from the Nationwide Emergency Department Sample (NEDS) but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of NEDS.


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This research was supported by unrestricted grants including Research to Prevent Blindness to the Wilmer Eye Institute (Baltimore, MD, USA) as well as from the VitreoRetinal Surgery Foundation in Edina, MN, USA (LT, MPB) and the Kogod Family (MPB).

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Each author contributed to the manuscript as follows: design and conduct of the study (LT, JC, AWS, FAW, MPB); collection, management, analysis, and interpretation of the data (LT, JC, MPB); preparation, review, or approval of the manuscript and decision to submit for publication (LT, JC, AWS, FAW, MPB).

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Correspondence to Mark P. Breazzano.

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Thangamathesvaran, L., Canner, J.K., Scott, A.W. et al. National emergency department trends for endogenous endophthalmitis: an increasing public health challenge. Eye (2022).

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