Infectious Sources, Prognostic Factors, and Visual Outcomes of Endogenous  Klebsiella pneumoniae  Endophthalmitis

Li, Yahan; Chen, Yihua; Chen, Kuan‐Jen; Wang, Nan-Kai; Sun, Ming‐Hui; Chao, An-Ning; Lin, Yi‐Hao; Wu, Wei‐Chi; Hwang, Yih‐Shiou; Lai, Chi-Chun; Chen, Tun-Lu

doi:10.1016/j.oret.2017.11.013

Cited by 23 publications

(26 citation statements)

References 26 publications

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“…To be clear, 53.01% (N = 44) cases had KP infection in the present study, and 40.96% EE were caused by liver abscess; whereas only 14.46% EE were induced by Gram-positive bacteria. The close relation between EE and liver abscess were also noticed in the previous case series, in which the sample population were all Asians 2 , 7 , 8 . Besides, 63.86% (N = 53) cases in our study had DM.…”

Section: Discussionsupporting

confidence: 80%

Clinicomicrobiological profile, visual outcome and mortality of culture-proven endogenous endophthalmitis in Taiwan

Hsieh

Chen

Cheng

et al. 2020

Sci Rep

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This is a retrospective study in consecutive cases with cultured-proven endogenous endophthalmitis (EE) treated at the largest tertiary medical center in middle Taiwan in the past 10 years. 83 eyes of 70 patients were enrolled. The mean interval between systemic diseases to the diagnosis of EE was 8.84 ± 6.94 days. The mean initial visual acuity (VA) in the logarithm of minimal angle of resolution (logMAR) was 1.63 ± 0.87. Type 2 diabetes mellitus was the most common predisposing medical illness (N = 53, 63.86%). The most common infectious sources were intra-abdominal abscess (N = 36, 43.37%), and the second most reason was urinary tract infection. The causative pathogen was Gram-negative predominant (N = 64, 77.11%). After aggressive treatment, 34.94% of eyes regain useful vision, and only six eyes underwent enucleation or evisceration. The binary multivariate logistic regression model revealed that female gender (95% CI 1.002–19.036, p = 0.05, OR 4.37), initial VA logMAR (95% CI 0.089–0.550, p = 0.01, OR 0.22), and more intravitreal injections (95% CI 0.368–0.927, p = 0.023, OR 0.58) were independent risk factors influencing final outcomes. Based on the results mentioned above, early diagnosis is recommended to gain better outcomes. The mean interval between systemic diseases to the diagnosis of EE was 8.84 ± 6.94 days in our sample population, clinicians should maintain a higher index of suspicion during this period when encountering patients with bacteremia or fungemia.

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Section: Discussionsupporting

confidence: 80%

Clinicomicrobiological profile, visual outcome and mortality of culture-proven endogenous endophthalmitis in Taiwan

Hsieh

Chen

Cheng

et al. 2020

Sci Rep

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“…One major problem is the culture positivity rate for these patients. In some Asian studies, a positive culture result in a blood sample varied from 57.1 to 94.74%, which is much higher than the rates found in aqueous and vitreous tap specimens [9, 10, 22]. Vitreous samples obtained from 7 patients were cultured, and K. pneumoniae was isolated in 6 patients (positive culture rate: 85.71%) in our study.…”

Section: Discussioncontrasting

confidence: 47%

“…One retrospective review showed poor initial VA worse than counting fingers and initial presentation with ocular symptoms before systemic symptoms were significant factors associated with poor outcomes [34]. We would like to add hypopyon and cornea oedema as another 2 risk factors, as has also been suggested by others [13, 22]. The appearance of hypopyon means that the bacteria have broken through the vitreous gel and zonules.…”

Section: Discussionmentioning

confidence: 95%

“…EKPE is highly associated with a new clinical entity named invasive liver abscess syndrome, which can also develop metastatic complications, including bacteraemia, meningitis and necrotizing fasciitis [29]. Li et al [22] found that 77.3% of EKPE cases had liver abscesses in Taiwan. As expected, we found that 40% of patients had liver abscesses in our research.…”

Section: Discussionmentioning

confidence: 99%

“…For some patients, such as case 3 in this study, open surgery may even be suggested. Li et al [22] found that drainage of a liver abscess may shorten the hospital course but does not affect visual outcomes or prevent enucleation. Third, local treatments include intravitreal injection of antibiotics, vitrectomy, evisceration and enucleation.…”

Section: Discussionmentioning

confidence: 99%

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Endogenous Endophthalmitis Caused by <b><i>Klebsiella pneumoniae</i></b>: 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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Endogenous Endophthalmitis

Berry

Yeh

2022

Albert and Jakobiec's Principles and Practice of Ophthalmology

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Infectious Sources, Prognostic Factors, and Visual Outcomes of Endogenous Klebsiella pneumoniae Endophthalmitis

Cited by 23 publications

References 26 publications

Clinicomicrobiological profile, visual outcome and mortality of culture-proven endogenous endophthalmitis in Taiwan

Clinicomicrobiological profile, visual outcome and mortality of culture-proven endogenous endophthalmitis in Taiwan

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

Endogenous Endophthalmitis

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