Epidemiology and outcomes of Endophthalmitis in chronic dialysis patients: a 13-year experience in a tertiary referral center in Taiwan

Abstract

BackgroundEndophthalmitis is a severe eye infection leading to disabling outcome. Because there were only a few case report illustrating endophthalmitis in chronic dialysis patient, we would like to investigate the epidemiology and clinical features of endophthalmitis in chronic dialysis patient in a tertiary referral center.MethodsWe searched the health information system in the study hospital with ICD9 encoding endophthalmitis during Jan. 2002 to Dec. 2015. A total of 32 episodes of endophthalmitis occurred in chronic dialysis patients. We performed an 1:2 case-control match on propensity score. The demographic features, clinical manifestation, infection focus and visual outcome were recorded.ResultsOf the total of 32 patients, 25 were classified as endogenous endophthalmitis and another seven were exogenous. Most patients presented with ophthalmalgia (n = 32, 100%) and periocular swelling (n = 31, 96.8%), whereas half of the patients suffered blurred vision (n = 16, 50%). Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the most frequent causative pathogens. Dialysis vascular infection was also a possible unique focus for bacteremia. The visual acuity of the endogenous groups were less likely to improve in the chronic dialysis patients compared with control group.ConclusionThis is the first and the largest case series focusing on endophthalmitis in chronic dialysis patients. Our study showed different pathogen spectrum, an unique bacterial origin and worse visual outcome in these group of patients. Prompt referral to ophthalmologists when the patients present with suspicious symptoms (blurred vision, ophthalmalgia and periocular swelling) is crucial.

Endogenous Endophthalmitis: A Review of Case Series Published between 2011 and 2020

“…Systemic treatment was recommended by all authors given the specific pathogeny of EE, and in some cases, it was the only therapy administered [ 41 , 45 ]. It should be started immediately after the blood samples for culture have been taken.…”

“…In 7 of 8 studies conducted in Southeast Asia, Gram-negative infections predominated (43.9% to 83.3% of patients) and K. pneumoniae was the most frequent microorganism (26.8% to 53% of patients) [ 6 , 12 , 17 , 30 , 41 – 44 ]. One exception was a study conducted in Taiwan on chronic dialysis patients, where Staphylococcus was the most frequent cause [ 45 ]. In two small series from Japan, the prevalent causes were Staphylococcus (57%) and Candida (30%) [ 6 , 46 ].…”

“…Considering that the path of the microorganism into the eye is by hematogenous spread, intravenous antibiotics/antifungals are used in all cases (in contrast, the guidelines do not support the use of intravenous treatment in endophthalmitis after cataract surgery) [ 50 ]. In some instances, systemic therapy was the only therapy administered (32% of chronic dialysis patients in a study) [ 41 , 45 ]. Only one author reported a low percentage of patients receiving systemic treatment for EFE (58.8% in yeast infections and 87.5% in mold infections) [ 23 ].…”

Epidemiology and Mortality-Related Prognostic Factors in Endophthalmitis

“…However, in patients without DM, endophthalmitis may be caused by different pathogens, including more invasive microorganisms, such as methicillinresistant Staphylococcus aureus (MRSA), bacilli, and fungi, depending on the primary source of the infection. 2,4,16 In a review article, Han 17 discussed the association of hepatic abscess from K. pneumoniae with DM and septic endophthalmitis; the author concluded that septic endophthalmitis in patients with a liver abscess due to gram-negative organisms other than K. pneumoniae is associated with a poor outcome. 17 Therefore, management of these patients can be more difficult, resulting in a higher rate of mortality.…”

Endogenous endophthalmitis: a not so rare ophthalmic emergency among hemodialysis patients

“…Metastatic infections complicate catheter-related bacteremia in 5-10% of cases, with endocarditis being the most frequent. EE is described as a rare metastatic infection, with few cases reported worldwide [7][8][9] .…”