Endogenous Klebsiella Research Articles

Clinical and Microbiological Characteristics of Endogenous Klebsiella pneumoniae Endophthalmitis in a Tertiary Hospital in Shanghai, China

ABSTRACT Purpose To investigate the clinical features of endogenous Klebsiella pneumoniae endophthalmitis (EKPE) and the molecular characteristics of pathogenic K. pneumoniae. Methods A retrospective study was conducted between January 2014 and January 2021. Clinical data were extracted. K. pneumoniae isolates cultured from EKPE patients’ specimens were characterized by antimicrobial susceptibility testing, multilocus sequence typing, capsular serotyping, and virulence gene profiles. Virulence phenotypes were confirmed by mouse lethality assay. Results Thirty-nine patients (47 eyes) were diagnosed with EKPE. Administration of systemic antibiotics and eye treatment within 24 hours of ocular symptom onset was statistically associated with better visual outcomes (p = .007). Sixteen K. pneumoniae isolates were collected, three of which were carbapenem-resistant and avirulent. Only salmochelin encoding gene was harbored by all isolates. Conclusions Systemic and eye treatment administered within 24 hours from the onset improves visual prognosis. Besides hypervirulent strains, avirulent carbapenem-resistant K. pneumoniae can cause EKPE.

Clinical characteristics of endogenous Klebsiella pneumoniae endophthalmitis: a 13-year experience

This study aimed to investigate the clinical features and risk factors for poor visual outcomes in patients with endogenous Klebsiella pneumoniae endophthalmitis (EKE). This retrospective interventional case series reviewed the medical records of 17 patients (21 eyes) with EKE from January 2007 to December 2019. Clinical findings, treatments, visual outcomes, and potential prognostic factors were evaluated. The mean age of the patients was 55.9years and 13 patients (76.5%) were males. Diabetes (23.5%) was the most commonly associated systemic disease and liver abscess (70.6%) was the major infection source. Poor initial visual acuity worse than counting fingers was significantly associated with poor final visual outcome (p = 0.003). In this study, adjunctive intravitreal dexamethasone injection and primary vitrectomy were not associated with final visual outcome. Secondary enucleation/evisceration was performed in 14.3%. EKE usually has a poor visual prognosis, and early diagnosis with fair initial visual acuity would be crucial in saving vision.

Clinical features and treatment outcomes of endogenous Klebsiella endophthalmitis: a 12-year review.

To identify the clinical features and treatment outcomes of endogenous Klebsiella pneumoniae endophthalmitis and investigate prognostic factors of poor visual outcome. The clinical records of all patients diagnosed with endogenous Klebsiella endophthalmitis between January 2007 to December 2018 in Prince of Wales Hospital, Hong Kong, China were retrospectively reviewed. Thorough ophthalmological examination findings were recorded in the case note, including visual acuity testing, slit-lamp examination, indirect ophthalmoscopy and B-scan ultrasonography if media opacity precluded fundus viewing. A total of 18 eyes in 14 patients were identified. Bilateral involvement was noted in 4 patients (28.6%). Hepatobiliary sepsis was the source in 9 patients (64.3%). Culture of intraocular fluid was positive in 5 out of 18 eyes (27.8%). Mortality was noted in 2 patients (14.3%). Mean final visual acuity was 20/1500. Six out of 16 eyes had total loss of sight (37.5%) and 3 eyes required evisceration (18.8%). Multivariate linear regression revealed poor presenting visual acuity (P=0.031) and lack of fundus view due to vitritis (P=0.02) as prognostic factors of poor visual outcome. Visual outcome of endogenous Klebsiella endophthalmitis is poor. Poor presenting visual acuity and lack of fundus view predict poor visual outcome. High index of suspicion for endophthalmitis is important in Klebsiella sepsis patients with complaints of ocular symptoms. Ophthalmological screening is recommended in non-communicable patients with Klebsiella sepsis.

Report of Four Cases of Endogenous Klebsiella Pneumoniae Endophthalmitis Originated from Liver Abscess with Eye Complaints as the Initial Presentations

ABSTRACT Purpose To report four cases of endogenous endophthalmitis (EE) secondary to Klebsiella pneumoniae liver abscess, and discuss their clinic features and outcomes. Methods Clinical data were collected by reviewing the medical records of four patients diagnosed with endogenous Klebsiella Pneumoniae endophthalmitis (EKPE) secondary to liver abscess. Results Four patients were diagnosed with EE. Two males and two females, with ages ranging from 33 to 63 years old. All patients presented with ocular symptoms initially. Liver abscesses were diagnosed during hospitalization. All cases were caused by Klebsiella Pneumoniae confirmed by blood or tissue cultures. All patients were treated with intravitreal antibiotic injection, and two of the patients had vitrectomy. At the end, all affected eyes underwent evisceration. One patient died of septic shock with multiple organ failures. Conclusion EE secondary to liver abscess with metastatic spread is a severe sight-threatening condition. The delayed discovery of liver abscess may hinder the diagnosis and treatment of the disease, which may be related to poor prognosis.

Effect of intravitreal ceftazidime injection on endogenous klebsiella pneumoniae endophthalmitis, a single center case series.

To report long-term outcomes of intravitreal ceftazidime injection in patients with endogenous Klebsiella pneumoniae endophthalmitis (EKPE).This was a retrospective observational case study, including 7 eyes from 6 patients with EKPE. The medical records from January 2010 to December 2018 were reviewed.Diagnosis of EKPE was made based on the finding of endophthalmitis with concurrent systemic infection and positive blood culture result. All patients received tap and intravitreal ceftazidime injection base on the results of antibiotics sensitivity test. Visual acuity ranged from no light perception to 20/60 at initial visit, and the final visual acuity was 20/20. Two eyes underwent evisceration after intravitreal injection.Intravitreal ceftazidime injection showed favorable results in patients with EKPE.

ENDOGENOUS KLEBSIELLA PNEUMONIAE ENDOPHTHALMITIS IN NORTHERN CALIFORNIA.

To report the clinical features, treatment modalities, and visual outcomes in 12 eyes with endogenous Klebsiella pneumoniae endophthalmitis (EKPE). The medical records of all patients diagnosed with EKPE at Stanford Hospital (Palo Alto, CA) and Santa Clara Valley County Hospital (Santa Clara, CA) from January 2000 to March 2017 were retrospectively reviewed. A total of 10 patients (12 eyes) were diagnosed with EKPE. The median age at presentation was 56, 80% were male, and 30% were non-Asian. Presenting visual acuities ranged from 20/20 to no light perception. Of the 12 eyes 10 received a tap and injection (range, 1-33 injections per eye), 2 eyes underwent primary enucleation or evisceration, and 1 patient underwent pars plana vitrectomy after tap and injection. Final visual acuities ranged from no light perception (six eyes) to 20/300 or better (five eyes). Five patients eventually underwent evisceration or enucleation. All cases were associated with positive blood and/or vitreous cultures and had concurrent systemic infection. Endogenous Klebsiella pneumoniae endophthalmitis is a rare, but devastating, ocular infection. Most cases in this series resulted in light perception vision or worse, and almost half required enucleation or evisceration. In light of the virulence of EKPE, early diagnosis and treatment should be initiated in all suspected cases.

Successful treatment of endogenous endophthalmitis with extensive subretinal abscess: a case report

BackgroundEndogenous endophthalmitis could lead to a devastating outcome without a prompt and appropriate management. We report a case of advanced endogenous Klebsiella pneumoniae endophthalmitis with extensive subretinal abscess that was successfully treated with a vitrectomy.Case presentationA systemically well 61-year-old man complained of ocular pain and visual decrease in his right eye for eighteen days. Ophthalmic examination showed dense inflammation in the anterior chamber and vitreous body. Systemic investigations discovered diabetes and no specific site of systemic infection was found after hospitalization. The inflammation continued to worsen after the intravitreal antibiotic injection. Therefore, a pars plana vitrectomy combined with phacoemulsification was performed. Intraoperatively, a white elevated, fluffy mass with the overlying retinal whitening and necrosis was revealed in superior periphery. In addition to this, extensive retinal hemorrhages and five adjacent subretinal whitish masses with exudative retinal detachment were observed in the posterior pole and inferior quadrants, which were suggestive of extensive subretinal abscess with intense overlying retinal inflammation. The excision of white fluffy mass superiorly was performed without retinotomy and aspiration of extensive subretinal abscess. The polymerase chain reaction of vitreous samples was positive for Klebsiella pneumonia. Intravitreal 2 mg/0.1 ml ceftazidime were repeated. Nine days after the surgery, the inflammation significantly subsided and the retina reattached. The patient was in a stable condition at subsequent visit eight months later.ConclusionThe delay in an accurate diagnosis and treatment caused extensive subretinal abscess combined with endogenous endophthalmitis. The treatment modality of subretinal abscess is typically individualized to the patient’s presentation. If the retina overlying the abscess is not necrotic, the extensive subretinal abscess can quickly absorbed after vitrectomy, retinotomy with aspiration of the abscess should be avoided to decrease the risk of retinal detachment.

Infectious Sources, Prognostic Factors, and Visual Outcomes of Endogenous Klebsiella pneumoniae Endophthalmitis

To investigate the infectious sources and prognostic factors for poor visual outcome, including subjective symptoms, presenting clinical features, laboratory data, and treatments, in patients diagnosed with endogenous Klebsiella pneumoniae endophthalmitis (EKE) at a tertiary referral center in Northern Taiwan. Retrospective, single-institution, consecutive case series. One hundred ten consecutive patients (124 eyes) diagnosed with EKE. One hundred ten patients (124 eyes) were reviewed retrospectively between January 1996 and April2013. Visual acuity (VA), subjective symptoms, presenting clinical features, laboratory data, treatments, and requirement of evisceration or enucleation. Of the 110 patients with EKE, 74 (67.3%) were men. Diabetes was the most commonly associated systemic disease (75/110 [68.2%]), and liver abscess was the major infection source (85/110 [77.3%]). In addition, 91 of 124 eyes (73.4%) had final VA worse than counting fingers (CF; poor visual outcome), and 20 eyes required evisceration or enucleation. The binary multivariate logistic regression (forward-Wald) model revealed that poor initial VA worse than CF (odds ratio [OR], 8.8; 95% confidence interval [CI], 2.2-36; P= 0.002), positive vitreous culture results (OR, 9.8; 95% CI, 1.7-56.1; P= 0.010), posterior focal EKE (OR, 0.15; 95% CI, 0.03-0.8; P= 0.027), and the presence of intravitreal dexamethasone administration (OR, 0.19; 95% CI, 0.04-0.9; P= 0.030) were the significant independent factors for visual outcomes. Liver abscess was the major infection source, and EKE typically has poor visual prognosis. Early diagnosis and prompt treatment may salvage useful vision in some eyes. Early diagnosis with fair initial VA and intravitreal antibiotic and dexamethasone combination therapy may have beneficial effects on visual outcomes.

Prevention of Evisceration or Enucleation in a Patient with Endogenous Klebsiella Panophthalmitis and Scleral Abscess

Prevention of Evisceration or Enucleation in a Patient with Endogenous Klebsiella Panophthalmitis and Scleral Abscess

Unique Presentation of Endogenous Klebsiella Endophthalmitis From a Pyogenic Hepatic Abscess

The following is a rare presentation of endogenous klebsiella endophthalmitis associated with a pyogenic liver abscess. A 64-year-old Cantonese male presented to our tertiary care center with subjective fevers and left eye vision loss. His vision loss began four days prior to presentation and was associated with progressive pain, swelling, and redness of the same eye. Orbital CT with contrast confirmed presence of both periorbital and post-septal orbital cellulitis, as well as endophthalmitis. Infection was presumed to be from an endogenous source given the patient's fevers, so the patient was started on intravenous vancomycin, ceftazidime, and metronidazole. Blood cultures taken in the emergency room prior to the administration of antibiotics revealed no growth over the next five days. A CT abdomen/pelvis obtained to determine an infectious source revealed a 7 cm x 5 cm liver abscess. Interventional radiology biopsy of the abscess displayed infection with pan-susceptible Klebsiella pneumoniae. Antibiotics were de-escalated to intravenous ceftriaxone and ophthalmology recommended evisceration of the left eye. Six sets of blood cultures all remained negative for Klebsiella bacteremia throughout the patient's hospital course. Klebsiella endophthalmitis is a rare but devastating infection associated with pyogenic hepatic abscesses, particularly in Asian populations. Patients with hepatic abscesses causing systemic symptoms generally present with right upper quadrant pain and sepsis secondary to bacteremia before the onset of ocular symptoms. Our patient uniquely presented with initial symptoms of vision loss coinciding with onset of fevers and had negative blood cultures further complicating diagnosis. Treatment of endogenous endophthalmitis involves intravenous and intravitreal antibiotics, however, infection is rapidly progressive and often leads to permanent vision loss requiring enucleation or evisceration of the eye. Given the low incidence of ophthalmic disease in patients with pyogenic hepatic abscesses, there are no current guidelines for routine ophthalmology screening in the absence of visual symptoms. However, physicians should monitor patients with known liver pathology, particularly those of Asian descent, for complaints of ocular symptoms.

Rising trends of endogenous Klebsiella pneumoniae endophthalmitis in Australia.

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. Retrospective observational case study and case series in the hospital setting. Four cases of EKPE. EKPE cases from 2005 to 2015 were identified through established endophthalmitis databases as well as hospital-based microbiological searches. EKPE cases were confirmed with positive K. pneumoniae intraocular samples. 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. 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.

Endogenous Klebsiella pneumoniae endophthalmitis associated with intravenous drug abuse

Endogenous Klebsiella pneumoniae endophthalmitis associated with intravenous drug abuse

Primera manifestación oftalmológica de una sepsis por Klebsiella. Importancia de la sospecha diagnóstica precoz

Case report A diabetic patient who developed a unilateral uveitis with a chorioretinitis patch in his right eye associated with decreased visual acuity and fever. Endogenous endophthalmitis was suspected and complementary tests were performed, finding hepatic abscesses with Klebsiella isolation in the biopsy. The ocular disorder slowly improved with intravenous therapy and guided percutaneous liver drainage. Conclusion Endogenous Klebsiella endophthalmitis is an uncommon condition with severe complications. An early diagnosis and aggressive antibiotic therapy can ameliorate the final course but the visual outcome still remains poor.

A Case of Renal Abscess associated with endogeneous endophthalmitis and septic pulmonary embolism byKlebsiella pneumoniae

Klebsiella pneumoniae is a pathogen that causes a wide range of infections in the human body and has a tendency to metastasize to multiple organs. Endogenous Klebsiella endophthalmitis is an infrequent but often devastating septic metastatic infection. It tends to be fulminant and often rapidly progresses to permanent visual loss beyond 24 hours after symptom onset, despite therapy with appropriate antibiotics, particularly with a delay in diagnosis and treatment. While endogenous Klebsiella endophthalmitis has mostly been reported in association with primary liver abscesses, it has rarely been reported with other Klebsiella infections including renal abscesses. Here, we present a case of a 73-year-old diabetic female diagnosed with a Klebsiella renal abscess and endogenous endophthalmitis, after developing left flank pain and bilateral decreased visual acuity. She was treated with systemic antibiotics, percutaneous abscess drainage, an intravitreal antibiotics injection, and a vitrectomy. While the renal abscess slowly resolved, the symptoms of endo- phthalmitis persisted despite treatment. This report suggests that endogenous endophthalmitis should be considered when diabetic patients with renal abscesses complain of ocular symptoms.

Prognostic Factors and Outcomes in Endogenous Klebsiella pneumoniae Endophthalmitis

To determine risk factors for poor visual acuity outcomes in patients with endogenous Klebsiella pneumoniae endophthalmitis. Retrospective case-control study. We reviewed all consecutive patients diagnosed with endogenous Klebsiella pneumoniae endophthalmitis over 20 years. Data collected included patients' demographics, clinical findings, investigations, and therapeutic intervention. Main outcome measures were visual acuity (VA) at 3 months postinfection and/or evisceration. Poor vision was defined as VA worse than 4/200. Seventy-one eyes of 61 patients were studied. Mean age was 55.7 (standard deviation [SD] ± 13.1) years. Majority were male (49/61, 80.3%), Chinese (51/61, 83.6%), and had hepatobiliary sepsis (47/61, 77.5%). Mean time to ocular symptoms was 4.4 (± 3.0) days. Fifty-four of 71 eyes (80.2%) had poor vision and 19/71 eyes (26.8%) required evisceration. The most significant risk factor was hypopyon (41/71 eyes, 57.7%) on multivariate analysis (odds ratio [OR], 52.6; 95% confidence interval [CI], 1.7-1000; P = .01). Unilateral involvement (OR, 10.4; 95% CI, 1.2-90.2; P = .01) and patients that were managed before year 2000 (before routine screening was implemented) (OR, 5.2; 95% CI, 1.5-17.9; P = .037) were significant risk factors for evisceration on multivariate analysis. Patients presenting with hypopyon and unilateral involvement have a poorer prognosis.

A Case of Endogenous Klebsiella Endophthalmitis Associated with Acute Urinary Tract Infection, Cellulitis in a Type 2 Diabetic Patient

A Case of Endogenous Klebsiella Endophthalmitis Associated with Acute Urinary Tract Infection, Cellulitis in a Type 2 Diabetic Patient

Endogenous Klebsiella pneumoniae endophthalmitis with renal abscess: Report of two cases

Klebsiella pneumoniae is one of the most common organisms causing endogenous endophthalmitis in East Asia. Herein we report the cases of two diabetic patients with K. pneumoniae renal abscess and endophthalmitis. Although endogenous endophthalmitis is rare, both internists and ophthalmologists should be alert to the possibility of endogenous endophthalmitis in diabetic patients caused by K. pneumoniae renal abscess. Intravitreal ceftazidime, amikacin, and corticosteroid at an appropriate dosage are required for cases of endogenous Klebsiella endophthalmitis.

Endogenous Klebsiella Endophthalmitis Associated with Klebsiella pneumoniae Pneumonia

Purpose: To investigate the management, bacterial strains, antibiotic sensitivities, and visual outcomes in patients with Klebsiella pneumoniae pneumonia and endogenous Klebsiella endophthalmitis. Methods: Data were collected for treatments, antibiotic sensitivity patterns, and final visual outcomes. Results: The study included 10 eyes of 9 patients with a median age of 42 years (range, 0–86 years). Diabetes mellitus was the most common comorbid risk factor (n = 5, 56%). Nine eyes (90%) were treated with intravitreal antibiotics, and one with pars plana vitrectomy and intravitreal antibiotics. One eye achieved a favorable visual acuity of 20/20; however, 6 eyes developed vision of no light perception, including 2 of evisceration. Two nosocomial K. pneumoniae isolates were extended-spectrum-β -lactamase-producing strains, which demonstrated the resistance to amikacin and ceftazidime. Conclusions: Ophthalmologists and physicians should be aware of Klebsiella pneumonia as a possible cause of endogenous endophthalmitis, and endogenous Klebsiella endophthalmitis usually causes poor visual outcomes.

Risk factors for endogenous Klebsiella endophthalmitis in patients with Klebsiella bacteraemia: a case–control study

Aim:To identify risk factors for Klebsiella endophthalmitis in patients with Klebsiella sepsis.Methods:This is a retrospective case–control study. The study population consisted of all patients with positive blood cultures for Klebsiella,...

Endogenous Klebsiella Endophthalmitis Concurrent with Prostate and Perianal Abscesses

Endogenous endophthalmitis is a sight-threatening ophthalmic emergency that requires vitrectomy unless prompt treatment is undertaken. It is usually caused by hematogenous spread from a distant endogenous focus of infection. We treated a patient with endogenous endophthalmitis who also had prostate and perianal abscesses caused by Klebsiella pneumoniae. Clinicians should entertain the possibility of endogenous endophthalmitis if a patient with a urologic disease such as a prostate abscess or acute prostatitis resulting in bacteremia complains of ophthalmologic symptoms. (Korean J Urol 2008;49:1055-1057) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏