Renal abscesses and endogenous endophthalmitis due to hypermucoviscous hypervirulent Klebsiella pneumoniae (HVKP)

Abstract

We describe a diabetic patient with left eye endogenous endophthalmitis due to hypervirulent hypermucoviscous Klebsiella pneumoniae (HKVP) originating from right renal abscesses. A rare source of HVKP causing endogenous endophthalmitis. Despite treatment with intravenous ceftazidime and pars plana vitrectomy, the patient required evisceration of the left eye. A high index of suspicion for endogenous endophthalmitis and awareness of the virulence and potential antibiotic resistance of HVKP strains in the community is needed to avoid vision and life-threatening consequences.

Hypervirulent Klebsiella pneumoniae Endogenous Endophthalmitis—A Global Emerging Disease

“…The median number of administrations in the reviewed studies was 3–5 [ 12 , 58 , 67 , 77 ]. However, Martel successfully treated a Kp subretinal abscess with intensive intravitreal ceftazidime and vancomycin, daily for one week, then at 48 h, with a total of 13 administrations [ 80 ].…”

“…However, Ang et al found that early vitrectomy is not associated with a better visual outcome [ 16 ]. Martel et al raised concern about the efficacy and results of PPV on an inflamed necrotic retina [ 80 ]. A vitrectomy could result in supplementary damage of the retina, especially if the vitreous body is not detached due to vitreoretinal tractions.…”

“…Early removal of vitreous abscess can favor rapid evacuation of the pathogen load and mediators of inflammations. A more conservative approach would indicate PPV only in eyes with VA severely decreasing a worsening grade of relative afferent pupillary defect with no response to intravitreal antibiotics for 48 h [ 18 , 80 ]. Choosing the surgical timing should take into account the general status of the patient, hemodynamics, and coagulation parameters, which can be affected during Klebsiella infection.…”

Infection Sources and Klebsiella pneumoniae Antibiotic Susceptibilities in Endogenous Klebsiella Endophthalmitis

“…Diabetic patients with K. pneumoniae hepatobiliary infections have a higher risk of developing endogenous K. pneumoniae endophthalmitis (EKE) [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. EKE has been found in patients with other infections, such as pneumonia and renal abscess [ 8 , 9 , 10 , 11 ]. K. pneumoniae isolates are typically susceptible to ceftazidime and amikacin, which are currently used empirically to treat endophthalmitis.…”