Endogenous Klebsiella Endophthalmitis Associated with Pyogenic Liver Abscess

Chang Sue Yang, Hsien Yang Tsai, Chun Sung Sung, Keng Hung Lin, Fenq Lih Lee, Wen-Ming Hsu

Research output: Contribution to journalArticle

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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. Design: Retrospective, noncomparative, interventional case series. Participants: 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. Main Outcome Measures: 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. Conclusion: 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.

Original languageEnglish
JournalOphthalmology
Volume114
Issue number5
DOIs
Publication statusPublished - May 1 2007
Externally publishedYes

Fingerprint

Pyogenic Liver Abscess
Endophthalmitis
Klebsiella
Klebsiella pneumoniae
Anti-Bacterial Agents
Abscess
Visual Acuity
Lung Abscess
Brain Abscess
Intravitreal Injections
Embolism
Meningitis
Medical Records
Prostate
Early Diagnosis
Diabetes Mellitus
Adrenal Cortex Hormones
Therapeutics

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Endogenous Klebsiella Endophthalmitis Associated with Pyogenic Liver Abscess. / Yang, Chang Sue; Tsai, Hsien Yang; Sung, Chun Sung; Lin, Keng Hung; Lee, Fenq Lih; Hsu, Wen-Ming.

In: Ophthalmology, Vol. 114, No. 5, 01.05.2007.

Research output: Contribution to journalArticle

Yang, Chang Sue ; Tsai, Hsien Yang ; Sung, Chun Sung ; Lin, Keng Hung ; Lee, Fenq Lih ; Hsu, Wen-Ming. / Endogenous Klebsiella Endophthalmitis Associated with Pyogenic Liver Abscess. In: Ophthalmology. 2007 ; Vol. 114, No. 5.
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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. Design: Retrospective, noncomparative, interventional case series. Participants: 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. Main Outcome Measures: 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. Conclusion: 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.",
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