Table 3.
Klebsiella pneumoniae endogenous endophthalmitis (EKE) in clinical studies.
| Author, Country, Year | Study Period | No of Cases/No of Eyes | Sex (M/F) | Age (Mean) |
Comorbidities | K.p. Strain | Focus of Infection (%) | Other Disseminations | Ocular Outcome | General Therapy | Ophthalmic Therapy |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Chiu CT59, Taiwan, 1988 | 1977–1986 | 3(5.2% incidence in KPLA) | 2/1 | 65 | diabetes (66.7%) | no info | hepatic | - | vision loss (3) enucleation (1) |
iv cephalosporins | topic antibiotics, mydriatics, CS a |
| Liao HR60, Taiwan, 1992 | 1983–1988 | 12 (25% bilateral) |
no info | no info | diabetes (91.66%) | no info | hepatic (50%) Others (urinar, pulmonary) |
- | no light perception (9); enucleation or evisceration (6) light perception (3) |
iv cephalosporins percutaneous drainage of KPLA if necessary | topic cephalosporin + gentamicin, mydriatics, CS |
| Cheng DL61, Taiwan, 1991 | 1981–1987 | 14; (14,2% bilateral) |
no info | no info | diabetes (50%) | No info | hepatic | lungs (4) CNS (3) prostate (1) |
12 -blindness 2—partial blindness |
general | Topic antibiotics |
| Fung C10, Taiwan, 2002 | 1991–1998 | 14 (10.44%); 134 |
3/1 | 56.4 | diabetes (93%) | K1 (85.7%) K2 (14.3%) |
hepatic | lungs (3) CNS (2) |
deceased (4) vision loss/very low vision (8) vision recovery (2) |
pigtail catheter drainage; iv 3rd generation cephalosporin + gentamicin, 2 weeks, continued with oral ciprofloxacin |
No info |
| Fang CT56, Taiwan, 2007 |
1997–2005 | 14 (12.6%); 177 28.5% bilateral |
8/6 | 58.2 | diabetes (93%; 78.4%) | K1 (92,85%) K2 (7.15%) |
hepatic | meningitis (8) spondylitis/diskitis (4) pneumonia (1) brain abscess (2) fasciitis (1) |
vision loss (8; 57.1%) limited vison (2; 14.2%) partial recovery (4;28.5%) |
pigtail catheter drainage; iv third generation cephalosporin + gentamicin |
Intravitreal antibiotics and CS |
| Yang CS55, Taiwan, 2007 | 1994–2001 | 22 (bilateral 22.7%) |
19/3 | 54.6 | diabetes (68%) | no info | hepatic | lungs (6) CNS (3) kidney (1) prostate (1) |
vision loss (89%), of which 41% anophthalmia VA > 1/10 (3 cases) |
iv cephalosporins and aminoglycosides | intravitreal antibiotic/CS enucleation/evisceration 41% |
| Sheu SJ12, Taiwan, 2011 | 1991–2009 | 42(6.9%); 602 (26% bilateral) |
26/16 | 60.2 | diabetes (35%) | no info | hepatic | no info | VA of CF or better in 35.8% | iv cephalosporins, intravitreal antibiotics; VIT (9 cases) | intravitreal ATB b -40 (amikacin 400 mg/ 0.1 mL, gentamicin 0.05 mg/0.1 mL, ceftazidime 2.25 mg/0.1 mL, and vancomycin 1 mg/0.1 mL intravitreal CS -12 VIT-9 enucleation/evisceration- 11 |
| Park IH13, South Korea, 2015 | 2004–2013 | 12 | 7/5 | 64.3 | diabetes (50%; 23.8%) | no info | hepatic (incidence in KPLA 6.1%) |
no info | NLP (7) HM c (3) Partial recovery (2) |
iv cephalosporins and aminoglycosides | intravitreal ceftazidime 2.25 mg/0.1 mL and vancomycin 1 mg/0.1 mL; early VIT |
| Lee JY 14, South Korea, 2014 | 1997–2013 | 8; | 5/3 | 71.1 | diabetes (50%) | no info | hepatic | no info | vision loss (7) partial recovery (1) |
iv ceftriaxone, | intravitreal antibiotics (7) |
| Pastagia M19, US, 2008 | 2001–2007 | 1 (bilateral EKE) | no info | no info | diabetes (100%) | K1 | hepatic | lungs, meninx (1) | bilateral vision loss | iv ceftriaxone /imipenem in cases with ESBL Intravitreal antibiotics |
no info |
| Chung CY15, Hong Kong, 2016 | 2006–2015 | 19 (bilateral 26.3%) | 12/7 | 67.89 | diabetes (11) hypertension (5) cirrhosis (2) Guillain-Barre (1) |
no info | liver 18 (94%) urinary 1 (6%) |
coagulopathy (1), shock (1) psoas (1) CNS (1) pleura (3) |
deceased (4) anophthalmia (9) total vision loss (3) VA > 0.3 (3) |
iv cefuroxime, gentamicin; | intravitreal ceftazidime and amikacin+/− vancomycin 17/19 (89.47%) VIT 3 (15.8%) evisceration 9 (47.4%) |
| Ang M16, Singapore, 2011 | 1986–2007 | 61/71 (18% bilateral) | 49/12 | 55.7 | diabetes (55.7%) | no info | liver 46 (77.5%) urinary 11 (9.9%) repiratory 3 (4.2) other 6 (8.4%) |
lungs (5) meningitis (5) urinary (7) |
evisceration (19;26.8%) VA < 20/400 55 (77.5%) VA > 20/400 16 (22.5%) |
iv ceftriaxone, | intravitreal vancomycin (2.0 mg/0.1 mL) plus ceftazidime (2.25 mg/0.1 mL) or amikacin (0.4 mg/0.1 mL). |
| Tan YM17, Singapore, 2003 | 1995–2001 | 10 (3.4%); 289 | 6/10 | 45.7 | diabetes 70% | no info | hepatic | skin emboli (1) pneumonia (1) ARDS d (2) pleural effusion (1) |
evisceration (2) vision loss (4) poor vision -HM (4) |
iv ceftriaxone and gentamicin/metronidazole | Intravitreal antibiotics, VIT |
| Odouard C22, Australia | 2011–2015 | 4 (50% bilateral) | 3/1 | 39.2 | diabetes (50%) | No info | hepatic | lungs (1) prostate (1) |
enucleation (1) vision loss (1) preserved vision >6/24 (2) |
iv ceftriaxone, hepatic abscess drainage | intravitreal ceftazidime and vancomycin, VIT |
| Shields RA30, 2017, US | 2000–2017 | 10/12 (20% bilateral) | 8/2 | 56 | diabetes 7 (70%) | liver 4 (40%) lungs 4 (40%) endocarditis 1 (10%) osteomyelitis 1 (10%) |
no info | anophthalmia 5/12 vision loss 2/12 VA > 20/300—5/12 |
iv antibiotics | intravitreal antibiotics (1–33 injections)–10/12 enucleation, evisceration 5/12 |
|
| Lim H31, 2014, S. Korea | 2005–2011 | 18/23 (27% bilateral) | 14/4 | 68.7 | diabetes-8 (44%) cirrhosis 4 (22%) psoriasis arthritis 1(5%) |
no info | KPLA 15 (85%) lungs (11%) prostate abscess 1(5%) |
no info | anophthalmia 1 (2.3%) total vision loss 13 (56%) VA> 0.05- 9 (39%) |
iv ceftazidime/ceftriaxone+ amikacin/metronidazole/tazocin /meropenem | intravitreal vancomycin, ceftazidime +/− gentamicin/amikacin VIT- 7 (30%) evisceration 1 (2.3%) |
| Chen SC84, 2016, Taiwan | 2002–2013 | 48/58 (20.8% bilateral) | 29/19 | 59.3 | diabetes 34 (70.8%) hypertension 17 (35.4%) malignancy 7 (14.6%) cirrhosis 4 (8.3%) |
no info | KPLA 33 (68.7%) Urinary 4 (8.3%) pneumonia 2 (4%) other 5 (10.4%) |
no info | anophthalmia 12 (20.6%) total vision loss 27 (46.5%) VA > 1/60 -19 (32%) |
iv antibiotics, according to antibiogram | intravitreal ceftazidime+/− vancomycin (3.8 + −2.6) – 100% intravitreal CS -27 (50%) VIT 18 (31%) evisceration/enucleation 12 (20.6%) |
| Wong JS64, 2000 | 1986–1998 | 18/20 (11% bilateral) | 10/8 | 49.3 | KPLA 15 (83%) pneumonia 2 (11.1%) urinary 1 (5.5%) |
No info | KPLA 15 (83%) pneumonia 2 (11%) urinary 1 (5%) |
no info | vision loss 15 (83%) AV > 0.05 3(17%) |
ceftriaxone+ imipenem/gentamicin/metronidazole | intravitreal cefazolin/ceftazidime + vancomycin/gentamicin -100% |
a CS: corticosteroids; b ATB: antibiotics; c HM: hand movement; d ARDS: acute respiratory distress syndrome.