Endogenous Klebsiella endophthalmitis associated with pyogenic liver abscess.
OBJECTIVE
To study risk factors, clinical features, treatment, and visual outcomes in patients with endogenous Klebsiella pneumoniae endophthalmitis (EKE) associated with K. pneumoniae-induced pyogenic liver abscess, and to investigate contributing factors in successfully treated cases.


METHODS
Retrospective, noncomparative, interventional case series.


METHODS
Review of medical records of 22 consecutive patients with EKE and pyogenic liver abscess.


METHODS
The affected eyes of 22 consecutive patients (n = 27) with EKE, who presented to our ophthalmic service during a recent 8-year period, were studied retrospectively.


METHODS
Best-corrected visual acuity (VA) at end of follow up.


RESULTS
Diabetes mellitus was the most common comorbid risk factor (n = 15 [68%]). Five patients (23%) had bilateral eye involvement. On initial presentation, characteristic pupillary hypopyon was observed in 12 eyes. Diagnosis was confirmed by blood culture in 8 patients, culture of liver aspirate in 17 patients, and vitreous culture in 11 patients. Other associated septic metastatic lesions included pulmonary abscess or emboli in 6 cases, brain abscess or meningitis in 3 cases, and prostate and kidney abscesses in 1 case. Despite aggressive intravenous and intravitreal antibiotic therapy, final VA of light perception or worse affected 24 eyes (89%), of which 11 (41%) were eventually eviscerated or enucleated. Successful treatment with retained useful vision better than 6/60 was achieved in 3 eyes, of which 2 received early intravitreal corticosteroid injections. However, the other remaining eye had a focal subretinal abscess.


CONCLUSIONS
Physicians should be alert to the development of EKE when patients with diabetes along with K. pneumoniae-induced pyogenic liver abscess complain of ocular symptoms. In the majority of patients with EKE associated with pyogenic liver abscess, visual outcome is generally poor despite aggressive antibiotic therapy. Early diagnosis and prompt intervention with intravitreal antibiotics within 48 hours may salvage useful vision in some patients with EKE.
Yang
Chang-Sue
CS
Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan. csyang@vghtpe.gov.tw
Tsai
Hsien-Yang
HY
Sung
Chun-Sung
CS
Lin
Keng-Hung
KH
Lee
Fenq-Lih
FL
Hsu
Wen-Ming
WM
D000328:Adult; D000368:Aged; D000617:Aminoglycosides / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D002443:Ceftriaxone / Q000627:therapeutic use; D048909:Diabetes Complications; D004359:Drug Therapy, Combination; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015353:Eye Enucleation; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000150:complications; D006801:Humans; D007710:Klebsiella Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000302:isolation & purification*; D046290:Liver Abscess, Pyogenic / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014792:Visual Acuity
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D002443:Ceftriaxone