Endogenous Endophthalmitis in the American and Korean Population: An 8-year Retrospective Study

Cho, Heeyoon; Shin, Yong Un; Siegel, Nicole H.; Yu, Hyeong Gon; Sobrin, Lucia; Patel, Achal; Durand, Marlene L.; Miller, Joan W.; Husain, Deeba

doi:10.1080/09273948.2016.1195000

Cited by 49 publications

(40 citation statements)

References 43 publications

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“…Because EKPE is usually reported in Southeast Asia, including Korea, Thailand and Japan, we usually think that its prevalence is higher in these areas [4, 6, 7, 10]. In fact, K. pneumoniae is becoming more prevalent in Australia, America and Europe, and some cases have also been reported in these countries [3, 17-19]. The EKPE boom in Asian populations is attributed to hypervirulent K. pneumoniae , which is associated with hypermucoviscosity and the K1 or K2 serotypes [20].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, some researchers speculate that differences in genetic susceptibility among different races may be another possible reason [4]. We compared the proportion of patients with EKPE among all EE cases in some published studies and found that it was approximately 15.8, 28, 26.8, 45.6–48.4 and 1.5% in Australia, Japan, Thailand, Korea and America, respectively [3, 4, 6, 7, 10, 19]. In our study, the proportion of patients with EKPE among all EE cases was 9.62% (10/104).…”

Section: Discussionmentioning

confidence: 99%

“…Generally, the causative pathogens show geographic diversity. Gram-positive and Candida organisms have more favourable visual outcomes and are responsible for most EE cases in European and American area [1, 3]. However, in eastern Asian countries or areas, the microbiological spectrum is dominated by gram-negative bacteria, which have a much poorer visual prognosis [4-6].…”

Section: Introductionmentioning

confidence: 99%

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Endogenous Endophthalmitis Caused by Klebsiella pneumoniae: A Ten-Year Retrospective Study in Western China

et al. 2020

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The aim of this study was to analyse the clinical features, microbiology results, management and outcomes of patients with endogenous endophthalmitis caused by Klebsiella pneumoniae in western China. Methods: A retrospective review of medical records of 10 eyes in 10 subjects diagnosed with endogenous K. pneumoniae endophthalmitis from January 2008 to December 2018 was undertaken. Results: The top 3 predisposing medical conditions included diabetes mellitus (50%), malignancy (20%) and cardiac stent implantation (10%). Extraocular infective foci were mainly found in the liver (40%), lungs (20%) and kidneys (10%). The positive culture rate was 85.71% (6/7) in vitreous samples, 83.33% (5/6) in blood samples and 100% (4/4) in body fluid samples. Only 20% of the patients, who had good initial visual acuity (VA) better than hand movement (HM), achieved a final VA better than 1.0 (log MAR). The mortality rate was 10%. Conclusions: Though the prognosis of endogenous K. pneumoniae endophthalmitis is often poor, patients with an initial VA better than HM may have a good prognosis under comprehensive treatments, including vitrectomy, systemic sensitive antibiotic injection and drainage of the primary infection loci.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Endogenous Endophthalmitis Caused by Klebsiella pneumoniae: A Ten-Year Retrospective Study in Western China

et al. 2020

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“…Only half of the patients with endogenous endophthalmitis in one series had symptoms of an underlying infection on presentation, and only 75% had positive blood cultures (67). Infections commonly associated with endogenous endophthalmitis include liver abscess, endocarditis, and urinary tract infection (67,68). Blood cultures are often positive in these cases but may be negative in cases due to transient bacteremia or fungemia, such as those related to i.v.…”

Section: Endogenous Endophthalmitismentioning

confidence: 99%

Bacterial and Fungal Endophthalmitis

2017

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Endophthalmitis is a severe eye infection that may result in permanent loss of useful vision in the affected eye. Most cases are exogenous and occur as a complication of cataract surgery, an intravitreal injection, or penetrating ocular trauma. Endogenous endophthalmitis results from hematogenous seeding of the eye by bacteria or fungi, but bacteremia or fungemia may be transient and patients may present without symptoms of systemic infection. Nearly all endophthalmitis patients present with decreased vision, and some also have eye pain. Eye examination usually reveals a hypopyon and intraocular inflammation. Diagnosis is clinical, supported by cultures of the vitreous and/or aqueous or by blood cultures in some endogenous cases. Molecular diagnostic techniques have been used in research laboratories for pathogen identification in endophthalmitis and offer the possibility of rapid diagnosis, including in culture-negative cases. Intravitreal injection of antibiotics is the most important component of treatment; some cases also benefit from surgical debridement of the vitreous by a vitrectomy. The visual outcome depends partly on the pathogen: coagulase-negative staphylococcal endophthalmitis has a better prognosis than does streptococcal endophthalmitis, for example. Endophthalmitis is a medical emergency, and prompt diagnosis and treatment are essential for saving vision.

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“…In some centers, fungus is frequently identified in endogenous endophthalmitis [14,19], accounting for approximately half of positive cultures, Candida being the most common pathogen [18,20]. Fungal infections may have better prognosis than bacterial [18,21]; however, this outcome is not consistent across the literature [22]. Candida may be associated with IVDA [20].…”

Section: Diagnostic Testingmentioning

confidence: 99%

Endogenous Endophthalmitis: yield of the diagnostic evaluation

et al. 2020

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Background: Endogenous endophthalmitis is an infection of the eye secondary to sepsis, occurring in 0.04-0.5% of bacteremia or fungemia. Risk factors include intravenous drug abuse (IVDA), diabetes, indwelling catheters, and immune suppression. Many patients have known or suspected bacteremia or fungemia; however, culture yield is reported to be low (approximately 50%). The purpose of this study is to elucidate the yield of diagnostic evaluation including microbial cultures over a 6.5 year period at an academic center in the United States. Methods: Retrospective chart review of patients with endogenous endophthalmitis at the University of Florida from June 2011 to February 2018. Results: Included are 40 eyes of 35 patients. Endophthalmitis was secondary to an endogenous source in 23.5% of all endophthalmitis cases observed. Intraocular culture positivity was 28.6% overall but was 0% after initiation of systemic antibiotics. Most commonly identified organisms from the eye were coagulase-negative Staphylococcus and Candida. Blood culture positivity was 48.6%, most commonly Staphylococcus. IVDA was noted with increasing frequency as a risk factor. Diagnosis of endophthalmitis upon hospital admission was associated with a higher intraocular culture positivity (P = 0.040) and a shorter hospital stay (P = 0.035). Computed tomography (CT) and magnetic resonance imaging (MRI) were the highest yield imaging modalities; X-ray and non-ocular ultrasound were less diagnostically useful. Echocardiogram was positive by transesophageal route (TEE) in 22% and in 9% by transthoracic (TTE) testing. Following discharge from the hospital, 48.4% of patients failed to follow up with outpatient ophthalmology. Conclusions: Based on the results of this study, the interdisciplinary team should consider directed imaging, eye cultures prior to antimicrobial administration, thorough history for IVDA, and caution with premature discharge from the hospital.

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Endogenous Endophthalmitis in the American and Korean Population: An 8-year Retrospective Study

Abstract: The predisposing conditions and responsible organisms for EE vary in different regions of the world. The visual prognosis was strongly influenced by the underlying pathogen.

Cited by 49 publications

References 43 publications

Endogenous Endophthalmitis Caused by <b><i>Klebsiella pneumoniae</i></b>: A Ten-Year Retrospective Study in Western China

Endogenous Endophthalmitis Caused by <b><i>Klebsiella pneumoniae</i></b>: A Ten-Year Retrospective Study in Western China

Bacterial and Fungal Endophthalmitis

Endogenous Endophthalmitis: yield of the diagnostic evaluation

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