title: Risk factors for endogenous endophthalmitis secondary to klebsiella pneumoniae liver abscess: 20-year experience in Southern Taiwan.
abstract: OBJECTIVE
  To identify the risk factors for endogenous endophthalmitis secondary to Klebsiella pneumoniae liver abscess.
  
  
  METHODS
  We conducted a retrospective review of medical records of 602 patients admitted with K. pneumoniae liver abscess from January 1991 to November 2009. Variables included age, sex, history, month of onset, systemic condition, initial and final visual acuities, slit-lamp biomicroscopy, intraocular pressure, fundus, course and treatment.
  
  
  RESULTS
  Endophthalmitis was identified in 42 patients (53 eyes). Nineteen eyes (35.8%) had final vision of counting fingers or better. Diabetes was significantly associated with the development of endophthalmitis (P = 0.003) and poor visual outcome (P = 0.019). Poor initial vision (worse than counting fingers) was also significantly related to the poor visual outcome of endophthalmitis (P < 0.001). Subgroup analysis of 9 vitrectomy cases showed that progressive anterior chamber reaction might be related to poor visual outcome. Moreover, patients whose disease onset was in winter were slightly more likely to develop endophthalmitis (P = 0.088).
  
  
  CONCLUSIONS
  Although the prognosis of endogenous K. pneumoniae endophthalmitis is generally poor, some eyes might be saved if treated early enough. Diabetes is a significant risk factor for the development of endogenous endophthalmitis and poor visual outcome in patients with K. pneumoniae liver abscess. Early vitrectomy might be considered in patients whose anterior chamber inflammation did not respond well to intravitreal antibiotics.
authors.affiliation: Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.
authors.forename: Shwu-Jiuan
authors.initials: SJ
authors.lastname: Sheu
authors.forename: Ya-Hsin
authors.initials: YH
authors.lastname: Kung
authors.forename: Tsung-Tien
authors.initials: TT
authors.lastname: Wu
authors.forename: Fang-Ping
authors.initials: FP
authors.lastname: Chang
authors.forename: Yu-Harn
authors.initials: YH
authors.lastname: Horng
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D048909:Diabetes Complications; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D058449:Intravitreal Injections; 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; D013624:Taiwan / Q000453:epidemiology; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids