Rising trends of endogenous Klebsiella pneumoniae endophthalmitis in Australia

Odouard, Capucine; Ong, Daini; Shah, Parth; Gin, Thomas; Allen, Penelope J; Downie, J. A.; Lim, Lyndell L; McCluskey, Peter

doi:10.1111/ceo.12827

Cited by 40 publications

(29 citation statements)

References 22 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%

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%

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

et al. 2020

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“…Vitrectomy rates were very low in 8.1% to 26.8% of cases. There was one exception, a small case series that reported vitrectomies performed in 100% of eyes [ 57 ].…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…Functional success was achieved in 16.6% to 50% of the eyes. The best success (50%) was in a small series where all eyes were subject to vitrectomy [ 57 ].…”

Section: Functional Successmentioning

confidence: 99%

Endogenous Endophthalmitis: A Review of Case Series Published between 2011 and 2020

Danielescu

Anton

Stanca

et al. 2020

Journal of Ophthalmology

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This is a literature review of 31 case series of endogenous endophthalmitis (EE) published in the last ten years, identified from a literature search of several databases (PubMed, EMBASE, and the Cochrane Library). While diabetes mellitus and malignancies remain the most frequently associated medical conditions, intravenous drug use is a significant risk factor (especially in the last years, in studies from Western countries). Ophthalmologic screening is recommended for candidaemia, but not in patients with sepsis of other aetiologies (however, the physician treating patients with sepsis must be well aware of EE). The most frequent Gram-positive microorganisms that cause EE are Staphylococcus and Streptococcus; the most frequent Gram-negative organism is Pseudomonas, and yeasts, probably Candida, usually cause fungal infections. In all-cause EE, prognostic factors of better visual outcomes are initial VA better than counting fingers, performing a pars plana vitrectomy (PPV), performing an intravitreal injection within the first 24 hours after clinical diagnosis, and the presence of a focal type of EE. In endogenous fungal endophthalmitis, more than 1/4 of patients have bilateral involvement. Blood samples have a low rate of positivity. Yeasts remain the most prevalent cause. Many authors report using azoles and echinocandins for systemic therapy (and voriconazole for intravitreal injections). Although PPV was performed in small proportions of eyes, the anatomical success rate is quite high. Klebsiella pneumoniae is an important cause of EE in Southeast Asia (and probably an emergent etiology in other regions), which is frequently associated with diabetes. There is a robust association with pyogenic liver abscess (PLA) (but in up to half of the cases, the diagnosis of EE precedes that of PLA). Blood cultures have a high diagnostic yield, while vitreous samples have a low yield. K. pneumoniae may carry antibiotic resistance. Anatomical and functional success rates are small, but they may be improved with PPV.

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“…In general, gram-negative organisms, especially Klebsiella pneumoniae (KP), are responsible for most cases of endogenous endophthalmitis in East Asia, whereas gram-positive organisms and fungi are the more frequent causative agents in North America and Europe [ 6 7 8 9 ]. In recent reports, a rising trend of KP infection has been observed worldwide [ 10 11 12 ]. In Taiwan, the primary source of infection in endophthalmitis during the past 20 years has been KP liver abscess [ 13 ].…”

Section: Endogenous Endophthalmitismentioning

confidence: 99%

Endophthalmitis

Sheu

2017

Korean J Ophthalmol

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Endophthalmitis is a rare but severe form of ocular inflammation due to infection of the intraocular cavity that can lead to irreversible visual loss if not treated properly and timely. It can be classified as exogenous or endogenous based on the transmission route of the infectious source. Exogenous endophthalmitis occurs when infecting organisms gain entry into the eye via direct inoculation, while endogenous endophthalmitis occurs when infectious agents hematogenously spread into the eye from a distant focus of infection. The diagnosis of endophthalmitis depends mostly on the clinical findings on ophthalmological examination. Delayed diagnosis of endogenous endophthalmitis can lead to not only visual loss, but also increased risk of mortality. Since ocular and systemic symptoms of endophthalmitis are usually non-specific, early diagnosis relies on the alertness of clinicians. Early diagnosis and proper treatment are keys to saving the eye. Following advances in vitreoretinal pharmacotherapy and surgical technology, early surgical intervention is the current trend in the management of endophthalmitis.

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Rising trends of endogenous Klebsiella pneumoniae endophthalmitis in Australia

Abstract: Background: Endogenous Klebsiella pneumoniae endophthalmitis (EKPE) is a well-known entity in South-East Asia. We demonstrate a range of differing clinical features and outcomes of EKPE, and highlight the increasing incidence of EKPE in major centres in Sydney and Melbourne, Australia.

Cited by 40 publications

References 22 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

Endogenous Endophthalmitis: A Review of Case Series Published between 2011 and 2020

Endophthalmitis

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