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KMID : 0882420120820020200
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Korean Journal of Medicine
2012 Volume.82 No. 2 p.200 ~ p.207
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Klebsiella pneumoniae as the Most Frequent Pathogen of Endogenous Endophthalmitis
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Park Ga-Young
Kim Shin-Woo
Kim Hye-In
Kwon Eu-Gene
Kim Hyo-Hoon
Jeong Ju-Young
Chang Hyun-Ha
Lee Jong-Myung
Kim Nung-Soo
Lee Shin-Won
Ryu Seong-Yeol
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Abstract
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Backgrounds/Aims:Endogenous endophthalmitis (EE) is rare. However, the visual outcome of patients with EE is very poor. Many cases of EE caused by Gram-negative bacterial infections have recently been reported. This study was conducted to explore the most frequent pathogens, diagnosis, and treatment outcomes of EE.
Methods:A retrospective analysis was carried out in 23 patients diagnosed with EE through clinical manifestations and ophthalmic examinations in three hospitals between January 2000 and April 2011. Samples from 23 patients with EE were analyzed microbiologically.
Results:Pathogens were identified in 18 (78%) of the 23 blood, liver aspirate, and/or vitreous humor samples. Klebsiella pneumoniae was the most frequent organism (13/23, 57%). Abdomino-pelvic imaging (21/23, 91%) was performed to evaluate the primary site of infection. The most common primary infection was liver abscess (14/23, 61%). Despite administration of intravenous antibiotics and intravitreal injection, only six of 23 patients showed improvements in visual acuity. Thirteen (57%) experienced worse visual acuity. Four (17%) were eventually enucleated.
Conslusions:In patients diagnosed with EE, abdomino-pelvic CT is required to exclude the presence of liver abscess. If a liver abscess is identified, percutaneous drainage should be considered. Considering the rapid progression and poor prognosis of EE, early diagnosis and immediate management are vital. We currently suggest that empiric antibiotics for treatment of EE should have activity against Gram-negative bacilli such as K. pneumoniae.
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KEYWORD
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Endophthalmitis, Klebsiella pneumoniae
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