Gram-Negative Endogenous Endophthalmitis: A Systematic Review

Abstract

Background: Gram-negative bacteria are causative agents of endogenous endophthalmitis (EBE). We aim to systematically review the current literature to assess the aetiologies, risk factors, and early ocular lesions in cases of Gram-negative EBE. Methods: All peer-reviewed articles between January 2002 and August 2022 regarding Gram-negative EBE were included. We conducted a literature search on PubMed and Cochrane Controlled Trials. Results: A total of 115 studies and 591 patients were included, prevalently Asian (98; 81.7%) and male (302; 62.9%). The most common comorbidity was diabetes (231; 55%). The main aetiologies were Klebsiella pneumoniae (510; 66.1%), Pseudomonas aeruginosa (111; 14.4%), and Escherichia coli (60; 7.8%). Liver abscesses (266; 54.5%) were the predominant source of infection. The most frequent ocular lesions were vitreal opacity (134; 49.6%) and hypopyon (95; 35.2%). Ceftriaxone (76; 30.9%), fluoroquinolones (14; 14.4%), and ceftazidime (213; 78.0%) were the most widely used as systemic, topical, and intravitreal anti-Gram-negative agents, respectively. The most reported surgical approaches were vitrectomy (130; 24.1%) and evisceration/exenteration (60; 11.1%). Frequently, visual acuity at discharge was no light perception (301; 55.2%). Conclusions: Gram-negative EBEs are associated with poor outcomes. Our systematic review is mainly based on case reports and case series with significant heterogeneity. The main strength is the large sample spanning over 20 years. Our findings underscore the importance of considering ocular involvement in Gram-negative infections.

Insights into the liver-eyes connections, from epidemiological, mechanical studies to clinical translation

“…Besides, clinical statistics could provide clues for relatively hidden illnesses, for nearly 50% of cases of gram-negative endogenous endophthalmitis (EBE) originate from liver abscesses [ 167 ], and patients with orthotopic liver transplants are susceptible to Aspergillus endophthalmitis with eyes being the second most common site of infection only to lung [ 168 ]. In addition, nearly half of UM patients develop metastases, with the liver being the most preferential site [ 95 , 169 ].…”

Encapsulation in Oxygen-Loaded Nanobubbles Enhances the Antimicrobial Effectiveness of Photoactivated Curcumin

“…A similar approach could potentially be used for many human bacterial diseases that occur on accessible mucosal surfaces, such as the skin, where staphylococci cause atopic dermatitis, if it were proven to be entirely biocompatible [12]. Other possible applications for which photoactivated curcumin could be used include oral mucosae, which can cause dentinal tubules diseases [13], vaginal mucosae, which can be a source for bacterial migration to the urinary tracts [14,15], and, possibly, endophthalmitis [16].…”

Predatory bacteria prevent the proliferation of intraocular Serratia marcescens and fluoroquinolone-resistant Pseudomonas aeruginosa

“…Endogenous endophthalmitis is frequently caused by Gram-negative bacteria that travel from the blood stream, through the blood-brain barrier and into the posterior portion of the eye [21,22]. There bacteria can rapidly proliferate, induce a damaging immune response, and cause damage to the tissues crucial for vision such as the retina.…”

“…This can lead to severe surgical interventions such as removal of the eye's content (evisceration) or the entire globe (enucleation). Endophthalmitis caused by Gram-negative bacteria such as Klebsiella pneumonia is especially prominent in Asia [21][22][23]. At our hospital the most frequent Gram-negative bacteria that cause endophthalmitis are Pseudomonas aeruginosa and Serratia marcescens, whereas bacteria from the Staphylococcus and Streptococcus genera are the most prominent overall [24].…”