Endogenous Endophthalmitis From a Klebsiella pneumoniae Liver Abscess: The Incidence, Risk Factors, and Utility of Imaging

Abstract

We investigated the rate of ophthalmologic examinations to detect endogenous endophthalmitis in patients with pyogenic liver abscesses (PLAs) and the incidence and risk factors of endophthalmitis from a PLA caused by Klebsiella pneumoniae (PLA-K). A retrospective case series METHODS: A total of 536 patients admitted to a university hospital in Korea, to treat PLAs during 2012-2022 were primarily included. The proportion of patients who were referred for ophthalmologic examinations was investigated and the incidence of endophthalmitis in 248 patients with PLA-K was calculated. Univariate and multivariate logistic regression analyses were performed to define risk factors including demographic characteristics, underlying diseases, radiological findings, and systemic conditions. A comprehensive ophthalmologic examination was performed in 73.7% of all patients with PLAs, and the incidence of endophthalmitis from a PLA-K was 7.3%. A liver abscess larger than 5 cm in size increased the incidence of endogenous endophthalmitis 4-fold compared to smaller abscesses (OR=4.01, 95% CI=1.02 - 15.78, P=.047), and portal or hepatic vein thrombophlebitis increased the incidence approximately 4-fold (OR=4.04, 95% CI=1.10 - 14.83, P=.036). Acute cholangitis was approximately 8-fold (OR=8.33, 95% CI=1.25 - 55.71, P=.029), and disseminated intravascular coagulation (DIC) was approximately 6-fold (OR=5.76, 95% CI=1.22 - 27.21, P=.027) more related to prevalence of endophthalmitis. Other extrahepatic infections increased the incidence approximately 43-fold (OR=43.06, 95% CI=10.14 - 182.90, P < .001). . Clinicians should consider the risk of endogenous endophthalmitis when PLA-K patients have large liver abscesses (> 5 cm), acute cholangitis, portal or hepatic vein thrombophlebitis, DIC, or other extrahepatic infections.