Clinicomicrobiological profile, visual outcome and mortality of culture-proven endogenous endophthalmitis in Taiwan

Abstract

This is a retrospective study in consecutive cases with cultured-proven endogenous endophthalmitis (EE) treated at the largest tertiary medical center in middle Taiwan in the past 10 years. 83 eyes of 70 patients were enrolled. The mean interval between systemic diseases to the diagnosis of EE was 8.84 ± 6.94 days. The mean initial visual acuity (VA) in the logarithm of minimal angle of resolution (logMAR) was 1.63 ± 0.87. Type 2 diabetes mellitus was the most common predisposing medical illness (N = 53, 63.86%). The most common infectious sources were intra-abdominal abscess (N = 36, 43.37%), and the second most reason was urinary tract infection. The causative pathogen was Gram-negative predominant (N = 64, 77.11%). After aggressive treatment, 34.94% of eyes regain useful vision, and only six eyes underwent enucleation or evisceration. The binary multivariate logistic regression model revealed that female gender (95% CI 1.002–19.036, p = 0.05, OR 4.37), initial VA logMAR (95% CI 0.089–0.550, p = 0.01, OR 0.22), and more intravitreal injections (95% CI 0.368–0.927, p = 0.023, OR 0.58) were independent risk factors influencing final outcomes. Based on the results mentioned above, early diagnosis is recommended to gain better outcomes. The mean interval between systemic diseases to the diagnosis of EE was 8.84 ± 6.94 days in our sample population, clinicians should maintain a higher index of suspicion during this period when encountering patients with bacteremia or fungemia.

Clinical Characteristics and Outcomes in 314 Japanese Patients with Bacterial Endophthalmitis: A Multicenter Cohort Study from J-CREST

“…This is not very surprising, as the same findings appear in the literature: eye pain [11], bacterial identification [29,48,49], and poor initial BCVA [11,25,26,29,30,33,50]. Other factors that have been reported as risk factors include: younger age (<85 years) [21], female sex [30], presence of an intraocular foreign body [25], a higher number of intravitreal injections [25,30], the type of injury (rupture) [26], retinal detachment [26,48], and proliferative vitreoretinopathy [26]. The most important risk factor for visual impairment at 12 weeks was poor initial BCVA.…”

“…In the present analyses, three factors (presence of eye pain, bacterial identification, and poor initial BCVA) significantly contributed to legal blindness, which suggests that a severe condition at baseline is a risk factor for later visual impairment. This is not very surprising, as the same findings appear in the literature: eye pain [11], bacterial identification [29,48,49], and poor initial BCVA [11,25,26,29,30,33,50]. Other factors that have been reported as risk factors include: younger age (<85 years) [21], female sex [30], presence of an intraocular foreign body [25], a higher number of intravitreal injections [25,30], the type of injury (rupture) [26], retinal detachment [26,48], and proliferative vitreoretinopathy [26].…”

“…Acute endophthalmitis appears as a postoperative complication within 1–2 weeks after the surgical intervention, most commonly on the third to fifth postoperative day [ 1 , 2 ]. In endogenous endophthalmitis (EnE), there is an infection focus (or foci) somewhere else in the body, and then the pathogens are transferred to the eye [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ].…”

Case Series on Endogenous Klebsiella pneumoniae Endophthalmitis: More Than Meets the Eye

“…Over the past three decades, the overall visual outcome in patients with EKE remains dismal despite early recognition and aggressive treatment. The overall rate of vision recovery surpassing counting fingers was around 22.64%-34% [ 12 - 13 ]. However, Hsieh MC et al have found out that with early recognition, better outcomes were obtained with a good prognosis related to initial VA, female gender, and the number of intravitreal injections.…”

“…However, Hsieh MC et al have found out that with early recognition, better outcomes were obtained with a good prognosis related to initial VA, female gender, and the number of intravitreal injections. Early intervention with pars plana vitrectomy did not change the visual outcome [ 13 ]. Our patients had delayed surgical intervention, as they were hemodynamically unstable and unfit for surgery.…”