title: Endogenous Klebsiella endophthalmitis associated with pyogenic liver abscess.
abstract: 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.
authors.affiliation: Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan. csyang@vghtpe.gov.tw
authors.forename: Chang-Sue
authors.initials: CS
authors.lastname: Yang
authors.forename: Hsien-Yang
authors.initials: HY
authors.lastname: Tsai
authors.forename: Chun-Sung
authors.initials: CS
authors.lastname: Sung
authors.forename: Keng-Hung
authors.initials: KH
authors.lastname: Lin
authors.forename: Fenq-Lih
authors.initials: FL
authors.lastname: Lee
authors.forename: Wen-Ming
authors.initials: WM
authors.lastname: Hsu
mesh_terms: 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
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D002443:Ceftriaxone