An eleven-year retrospective study of endogenous bacterial endophthalmitis

Takashi Nishida, Kyoko Ishida, Yoshiaki Niwa, Hideaki Kawakami, Kiyofumi Mochizuki, Kiyofumi Ohkusu, Takashi Nishida, Kyoko Ishida, Yoshiaki Niwa, Hideaki Kawakami, Kiyofumi Mochizuki, Kiyofumi Ohkusu

Abstract

Purpose. To determine the clinical features, microbial profiles, treatment outcomes, and prognostic factors for endogenous bacterial endophthalmitis (EBE). Methods. The medical records of 27 eyes of 21 patients diagnosed with EBE for 11 years were reviewed. Collected data included age, site of infection, visual acuities (VAs), microbial profiles, and treatment regimen. Results. The mean age was 68.5 years. Gram-positive organisms accounted for 76.2%, while gram-negative ones accounted for 19.0%. Staphylococcus aureus was the most common causative organism (52.3%) of which 72.7% was methicillin-resistant S. aureus. A final VA of ≥20/40 was achieved in 44% and 20/200 or better was in 64%. Eyes with initial VA of ≥20/200 (P = 0.003) and focal involvements (P = 0.011) had significantly better final VA. Initial VA (P = 0.001) and the interval between onset of ocular symptoms and intravitreal antibiotic injection (P = 0.097) were associated with final VA in eyes receiving intravitreal antibiotics. Conclusions. EBE is generally associated with poor visual outcome; however the prognosis may depend on initial VA, extent of ocular involvement, and an interval between onset of ocular symptoms and intravitreal antibiotic injection. Early diagnosis and early intravitreal injection supplement to systemic antibiotics might lead to a relatively good visual outcome.

Figures

Figure 1
Figure 1
Visual outcome of endogenous bacterial endophthalmitis. CF, counting fingers; HM, hand motion; LP, light perception; NLP, no light perception (including enucleation); Pan, panophthalmitis; PD, posterior diffuse; PF, posterior focal.

References

    1. Jackson T. L., Paraskevopoulos T., Georgalas I. Systematic review of 342 cases of endogenous bacterial endophthalmitis. Survey of Ophthalmology. 2014;59(6):627–635. doi: 10.1016/j.survophthal.2014.06.002.
    1. Okada A. A., Johnson R. P., Liles W. C., D'Amico D. J., Baker A. S. Endogenous bacterial endophthalmitis: report of a ten-year retrospective study. Ophthalmology. 1994;101(5):832–838. doi: 10.1016/s0161-6420(13)31255-x.
    1. Jackson T. L., Eykyn S. J., Graham E. M., Stanford M. R. Endogenous bacterial endophthalmitis: a 17-year prospective series and review of 267 reported cases. Survey of Ophthalmology. 2003;48(4):403–423. doi: 10.1016/s0039-6257(03)00054-7.
    1. Wu Z. H. Y., Chan R. P. S., Luk F. O. J., et al. Review of clinical features, microbiological spectrum, and treatment outcomes of endogenous endophthalmitis over an 8-year period. Journal of Ophthalmology. 2012;2012:5. doi: 10.1155/2012/265078.265078
    1. Ho V., Ho L. Y., Ranchod T. M., Drenser K. A., Williams G. A., Garretson B. R. Endogenous methicillin-resistant Staphylococcus aureus endophthalmitis. Retina. 2011;31(3):596–601. doi: 10.1097/iae.0b013e3181ecccf0.
    1. Greenwald M. J., Wohl L. G., Sell C. H. Metastatic bacterial endophthalmitis: a contemporary reappraisal. Survey of Ophthalmology. 1986;31(2):81–101. doi: 10.1016/0039-6257(86)90076-7.
    1. Romero C. F., Rai M. K., Lowder C. Y., Adal K. A. Endogenous endophthalmitis: case report and brief review. American Family Physician. 1999;60(2):510–514.
    1. Yonekawa Y., Chan R. V. P., Reddy A. K., Pieroni C. G., Lee T. C., Lee S. Early intravitreal treatment of endogenous bacterial endophthalmitis. Clinical & Experimental Ophthalmology. 2011;39(8):771–778. doi: 10.1111/j.1442-9071.2011.02545.x.
    1. Kawakami H., Sawada A., Mochizuki K., Takahashi K., Muto T., Ohkusu K. Endogenous Nocardia farcinica endophthalmitis. Japanese Journal of Ophthalmology. 2010;54(2):164–166. doi: 10.1007/s10384-009-0782-4.
    1. Suemori S., Sawada A., Komori S., Mochizuki K., Ohkusu K., Takemura H. Case of endogenous endophthalmitis caused by Streptococcus equisimilis . Clinical Ophthalmology. 2010;4(1):917–918.
    1. Sawada A., Komori S., Udo K., et al. Case of endogenous endophthalmitis caused by Klebsiella pneumoniae with magA and rmpA genes in an immunocompetent patient. Journal of Infection and Chemotherapy. 2013;19(2):326–329. doi: 10.1007/s10156-012-0468-6.
    1. Lee S., Um T., Joe S. G., et al. Changes in the clinical features and prognostic factors of endogenous endophthalmitis: fifteen years of clinical experience in Korea. Retina. 2012;32(5):977–984. doi: 10.1097/iae.0b013e318228e312.
    1. Kennerdell J., Tyutyunikov A., Edwards R., et al. The ischemic optic neuropathy decompression trial (IONDT): design and methods. Controlled Clinical Trials. 1998;19(3):276–296. doi: 10.1016/s0197-2456(98)00003-8.
    1. Deramo V. A., Cox T. A., Syed A. B., Lee P. P., Fekrat S. Vision-related quality of life in people with central retinal vein occlusion using the 25-item National Eye Institute Visual Function Questionnaire. Archives of Ophthalmology. 2003;121(9):1297–1302. doi: 10.1001/archopht.121.9.1297.
    1. Tanaka M., Kobayashi Y., Takebayashi H., Kiyokawa M., Qiu H. Analysis of predisposing clinical and laboratory findings for the development of endogenous fungal endophthalmitis. A retrospective 12-year study of 79 eyes of 46 patients. Retina. 2001;21(3):203–209. doi: 10.1097/00006982-200106000-00001.
    1. Murdoch D. R., Corey R. G., Hoen B., et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Archives of Internal Medicine. 2009;169(5):463–473. doi: 10.1001/archinternmed.2008.603.
    1. Kuriyan A. E., Weiss K. D., Flynn H. W., et al. Endophthalmitis caused by streptococcal species: clinical settings, microbiology, management, and outcomes. American Journal of Ophthalmology. 2014;157(4):774–780. doi: 10.1016/j.ajo.2013.12.026.
    1. Ness T., Pelz K., Hansen L. L. Endogenous endophthalmitis: microorganisms, disposition and prognosis. Acta Ophthalmologica Scandinavica. 2007;85(8):852–856. doi: 10.1111/j.1600-0420.2007.00982.x.
    1. Ness T., Schneider C. Endogenous endophthalmitis caused by methicillin-resistant Staphylococcus aureus (MRSA) Retina. 2009;29(6):831–834. doi: 10.1097/iae.0b013e3181a3b7a1.
    1. Wong J.-S., Chan T.-K., Lee H.-M., Chee S.-P. Endogenous bacterial endophthalmitis: an East Asian experience and a reappraisal of a severe ocular affliction. Ophthalmology. 2000;107(8):1483–1491. doi: 10.1016/s0161-6420(00)00216-5.
    1. Sng C. C. A., Jap A., Chan Y. H., Chee S. P. Risk factors for endogenous Klebsiella endophthalmitis in patients with Klebsiella bacteremia: a case-control study. British Journal of Ophthalmology. 2008;92(5):673–677. doi: 10.1136/bjo.2007.132522.
    1. Connell P. P., O'Neill E. C., Fabinyi D., et al. Endogenous endophthalmitis: 10-year experience at a tertiary referral centre. Eye. 2011;25(1):66–72. doi: 10.1038/eye.2010.145.
    1. Ang M., Jap A., Chee S.-P. Prognostic factors and outcomes in endogenous Klebsiella pneumoniae endophthalmitis. American Journal of Ophthalmology. 2011;151(2):338–e2. doi: 10.1016/j.ajo.2010.08.036.
    1. Chung K. S., Kim Y. K., Song Y. G., et al. Clinical review of endogenous endophthalmitis in Korea: a 14-year review of culture positive cases of two large hospitals. Yonsei Medical Journal. 2011;52(4):630–634. doi: 10.3349/ymj.2011.52.4.630.
    1. Lim H. W., Shin J. W., Cho H. Y., et al. Endogenous endophthalmitis in the korean population: a six-year retrospective study. Retina. 2014;34(3):592–602. doi: 10.1097/iae.0b013e3182a2e705.
    1. Kashani A. H., Eliott D. The emergence of Klebsiella pneumoniae endogenous endophthalmitis in the USA: basic and clinical advances. Journal of Ophthalmic Inflammation and Infection. 2013;3(1, article 28) doi: 10.1186/1869-5760-3-28.
    1. Hatano H., Inoue K., Matoba H., et al. Endophthalmitis in Japan—a nationwide study with reference to type and etiology. Nihon Ganka Gakkai Zasshi. 1991;95(4):369–376.
    1. Torisaki M., Sakai N., Yonewaki K., Funada H. Two cases of endophthalmitis caused by Klebsiella pneumoniae metastatic from pyogenic liver abscess. Journal of Eye. 2000;17(3):395–401.
    1. Hunt J. J., Wang J.-T., Callegan M. C. Contribution of mucoviscosity-associated gene A (magA) to virulence in experimental Klebsiella pneumoniae endophthalmitis. Investigative Ophthalmology and Visual Science. 2011;52(9):6860–6866. doi: 10.1167/iovs.11-7798.
    1. Wiskur B. J., Hunt J. J., Callegan M. C. Hypermucoviscosity as a virulence factor in experimental Klebsiella pneumoniae endophthalmitis. Investigative Ophthalmology & Visual Science. 2008;49(11):4931–4938. doi: 10.1167/iovs.08-2276.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere