title: 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.
  
  
  METHODS
  Retrospective observational case study and case series in the hospital setting.
  
  
  METHODS
  Four cases of EKPE.
  
  
  METHODS
  EKPE cases from 2005 to 2015 were identified through established endophthalmitis databases as well as hospital-based microbiological searches.
  
  
  METHODS
  EKPE cases were confirmed with positive K. pneumoniae intraocular samples.
  
  
  RESULTS
  Rising trends of EKPE were noted in major centres in Australia. Six eyes of four patients with EKPE from January 2011 to December 2015 are reported. The mean age was 49 years (range 43-58 years). Two patients had bilateral involvement. There were systemic symptoms up to 10 days prior to ocular symptoms. The source of sepsis in all cases was a hepatic abscess. Two patients had diabetes mellitus. Five eyes had hypopyon panuveitis on presentation. All eyes underwent vitrectomy. The patient with the most delayed presentation underwent enucleation following globe perforation. Final best corrected visual acuity (BCVA) in one patient with bilateral EKPE was light perception (LP) only. The other three eyes had BCVA in at least one eye of 6/24 or better.
  
  
  CONCLUSIONS
  EKPE is an emerging condition in Australia. Although rare, EKPE is a sight-threatening and potentially life-threatening emergency that can initially present to ophthalmologists. One should suspect EKPE in septic patients with a B-scan showing a vitreous or retinal abscess.
authors: Sydney Hospital and Sydney Eye Hospital, Sydney, New South Wales, Australia.|Prince of Wales Hospital, Randwick, New South Wales, Australia.
authors: Capucine
authors: C
authors: Odouard
authors: Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia.|Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.
authors: Daini
authors: D
authors: Ong
authors: Prince of Wales Hospital, Randwick, New South Wales, Australia.
authors: Parth R
authors: PR
authors: Shah
authors: Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.|Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors: Thomas
authors: T
authors: Gin
authors: Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia.|Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.
authors: Penelope J
authors: PJ
authors: Allen
authors: Sydney Hospital and Sydney Eye Hospital, Sydney, New South Wales, Australia.|Prince of Wales Hospital, Randwick, New South Wales, Australia.
authors: John
authors: J
authors: Downie
authors: Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia.|Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.|Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors: Lyndell L
authors: LL
authors: Lim
authors: Sydney Hospital and Sydney Eye Hospital, Sydney, New South Wales, Australia.|Prince of Wales Hospital, Randwick, New South Wales, Australia.|Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia.
authors: Peter
authors: P
authors: McCluskey
mesh_terms: D000328:Adult; D009877:Endophthalmitis / Q000453:epidemiology* / Q000382:microbiology; D015818:Eye Infections, Bacterial / Q000453:epidemiology* / Q000382:microbiology; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007711:Klebsiella pneumoniae / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009517:New South Wales / Q000453:epidemiology; D012189:Retrospective Studies; D014739:Victoria / Q000453:epidemiology
keywords: Australia; Klebsiella pneumoniae; endogenous endophthalmitis; infectious endophthalmitis