Prevalence of and risk factors for endogenous endophthalmitis in patients with pyogenic liver abscesses

Abstract

Background/AimsAlthough pyogenic liver abscesses (PLAs) can be successfully treated, the visual prognosis of patients with endogenous endophthalmitis (EE) associated with a PLA is poor. Early diagnosis and prompt intervention may salvage useful vision. Therefore, we investigated risk factors for EE in patients with PLA, to facilitate early diagnosis.MethodsData from 626 patients diagnosed with PLA between January 2004 and July 2013 were analyzed retrospectively. Patients were divided into two groups: those with liver abscess-associated endogenous endophthalmitis (LAEE) and non-LAEE.ResultsThe prevalence of EE in PLA patients was 1.92%. The mean age for all patients (373 males, 59.6%) was 62.8 years. Upon multivariate logistic regression, a liver abscess or another systemic infection (odds ratio [OR], 5.52; p = 0.005), an abscess in the right superior segment (OR, 5.26; p = 0.035), and Klebsiella pneumoniae infection (OR, 3.68; p = 0.039), were risk factors for LAEE. The final visual outcomes of patients with LAEE included no light perception in seven, hand motion only in three, and decreased visual acuity in two. Vitrectomy and early intravitreal injections of antibiotics improved visual acuity and preserved useful vision.ConclusionsPLA patients with other systemic infections, abscesses in the right superior segment, and K. pneumoniae infection require close monitoring and early intervention to treat LAEE. Intravitreal antibiotic injections or early vitrectomy may salvage useful vision.

Endophthalmitis

“…Although it is caused by hematogenous spread, endogenous endophthalmitis tends to develop unilaterally, with the right eye more commonly affected, possibly due to the more proximal and direct arterial route from the heart to the right carotid artery. Several risk factors for endogenous endophthalmitis have been reported, including chronic metabolic diseases, immunosuppression, malignancy, intravenous drug abuse, long-term presence of an intracorporeal foreign body, and invasive surgery [ 13 14 15 16 ]. According to a worldwide systematic survey of endogenous bacterial endophthalmitis, diabetes was the most common predisposing medical condition, and liver abscess was the most common extraocular focus of infection [ 17 ].…”

Endogenous Endophthalmitis: A Five-year Review of Cases at the Raja Perempuan Zainab II Hospital, Kelantan, Malaysia

“…Moreover, among patients with systemic Klebsiella infection, 7.3% were found to have EE caused by Klebsiella pneumoniae [ 9 ]. Another study found that a liver abscess in the right superior segment positive for K. pneumoniae infection was a significant risk factor for EE [ 10 ]. Thus, patients admitted for a liver abscess or systemic K. pneumoniae infection should be monitored closely for endophthalmitis.…”

Rising trends of endogenous Klebsiella pneumoniae endophthalmitis in Australia

“…KPLA infection exhibits a typical geographical distribution. The majority of cases have been reported from Taiwan, and cases have also been reported across Asia including Japan, Korea and Singapore . KPLA with endogenous spread was rarely reported in Western countries.…”

“…EKPE is now the commonest cause of endogenous endophthalmitis in Asia, with up to 9% prevalence in patients with KPLA . The incidence of metastatic spread is 100‐fold higher in Klebsiella sepsis compared to sepsis caused by other organisms .…”

“…4 EKPE is now the commonest cause of endogenous endophthalmitis in Asia, with up to 9% prevalence in patients with KPLA. 3,10,13 The incidence of metastatic spread is 100-fold higher in Klebsiella sepsis compared to sepsis caused by other organisms. 13 The greater virulence of the K1 capsule serotype strain has been identified as the major risk factor for development of metastatic complications.…”