Prevalence of and risk factors for endogenous endophthalmitis in patients with pyogenic liver abscesses
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background/Aims: Although pyogenic liver abscesses (PLAs) can be successfully treated, the visual prognosis of patients with endogenous endophthalmitis (EE) associated with a PLA is poor. Early diagnosis and prompt intervention may salvage useful vision. Therefore, we investigated risk factors for EE in patients with PLA, to facilitate early diagnosis. Methods: Data from 626 patients diagnosed with PLA between January 2004 and July 2013 were analyzed retrospectively. Patients were divided into two groups: those with liver abscess-associated endogenous endophthalmitis (LAEE) and non- LAEE. Results: The prevalence of EE in PLA patients was 1.92%. The mean age for all patients (373 males, 59.6%) was 62.8 years. Upon multivariate logistic regression, a liver abscess or another systemic infection (odds ratio [OR], 5.52; p = 0.005), an abscess in the right superior segment (OR, 5.26; p = 0.035), and Klebsiella pneumoniae infection (OR, 3.68; p = 0.039), were risk factors for LAEE. The final visual outcomes of patients with LAEE included no light perception in seven, hand motion only in three, and decreased visual acuity in two. Vitrectomy and early intravitreal injections of antibiotics improved visual acuity and preserved useful vision. Conclusions: PLA patients with other systemic infections, abscesses in the right superior segment, and K. pneumoniae infection require close monitoring and early intervention to treat LAEE. Intravitreal antibiotic injections or early vitrectomy may salvage useful vision.
Abstract
Background/Aims: Although pyogenic liver abscesses (PLAs) can be successfully treated, the visual prognosis of patients with endogenous endophthalmitis (EE) associated with a PLA is poor. Early diagnosis and prompt intervention may salvage useful vision. Therefore, we investigated risk factors for EE in patients with PLA, to facilitate early diagnosis. Methods: Data from 626 patients diagnosed with PLA between January 2004 and July 2013 were analyzed retrospectively. Patients were divided into two groups: those with liver abscess-associated endogenous endophthalmitis (LAEE) and non- LAEE. Results: The prevalence of EE in PLA patients was 1.92%. The mean age for all patients (373 males, 59.6%) was 62.8 years. Upon multivariate logistic regression, a liver abscess or another systemic infection (odds ratio [OR], 5.52; p = 0.005), an abscess in the right superior segment (OR, 5.26; p = 0.035), and Klebsiella pneumoniae infection (OR, 3.68; p = 0.039), were risk factors for LAEE. The final visual outcomes of patients with LAEE included no light perception in seven, hand motion only in three, and decreased visual acuity in two. Vitrectomy and early intravitreal injections of antibiotics improved visual acuity and preserved useful vision. Conclusions: PLA patients with other systemic infections, abscesses in the right superior segment, and K. pneumoniae infection require close monitoring and early intervention to treat LAEE. Intravitreal antibiotic injections or early vitrectomy may salvage useful vision.
참고문헌 (21)
- Yu SC, "Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration", Hepatology, 39, pp.932~938 (2004)
- Alvarez Perez JA, "Clinical course, treatment, and multivariate analysis of risk factors for pyogenic liver abscess", Am J Surg, 181, pp.177~186 (2001)
- Fang CT, "Klebsiella pneumonia genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess", Clin Infect Dis, 45, pp.284~293 (2007)
- Wang JH, "Primary liver abscess due to Klebsiella pneumoniae in Taiwan", Clin Infect Dis, 26, pp.1434~1438 (1998)
- Chung DR, "Emerging invasive liver abscess caused by K1 serotype Klebsiella pneumoniae in Korea", J Infect, 54, pp.578~583 (2007)
- Sheu SJ, "Risk factors for endogenous endophthalmitis secondary to klebsiella pneumoniae liver abscess: 20-year experience in Southern Taiwan", Retina, 31, pp.2026~2031 (2011)
- Chen YJ, "A 10-year comparison of endogenous endophthalmitis outcomes: an east Asian experience with Klebsiella pneumoniae infection", Retina, 24, pp.383~390 (2004)
- Yang CS, "Endogenous Klebsiella endophthalmitis associated with pyogenic liver abscess", Ophthalmology, 114, pp.876~880 (2007)
- Hu CC, "A one-year follow-up study on the incidence and risk of endophthalmitis after pyogenic liver abscess", Ophthalmology, 119, pp.2358~2363 (2012)
- Lee S, "Changes in the clinical features and prognostic factors of endogenous endophthalmitis:fifteen years of clinical experience in Korea", Retina, 32, pp.977~984 (2012)
- Sng CC, "Risk factors for endogenous Klebsiella endophthalmitis in patients with Klebsiella bacteraemia: a case-control study", Br J Ophthalmol, 92, pp.673~677 (2008)
- Smith D, "Sonographic demonstration of Couinaud’s liver segments", J Ultrasound Med, 17, pp.375~381 (1998)
- Yang CC, "Pyogenic liver abscess in Taiwan: emphasis on gas-forming liver abscess in diabetics", Am J Gastroenterol, 88, pp.1911~1915 (1993)
- Lau YJ, "Identification of a major cluster of Klebsiella pneumoniae isolates from patients with liver abscess in Taiwan", J Clin Microbiol, 38, pp.412~414 (2000)
- Fung CP, "A global emerging disease of Klebsiella pneumoniae liver abscess: is serotype K1 an important factor for complicated endophthalmitis?", Gut, 50, pp.420~424 (2002)
- Saccente M., "Klebsiella pneumoniae liver abscess, endophthalmitis, and meningitis in a man with newly recognized diabetes mellitus", Clin Infect Dis, 29, pp.1570~1571 (1999)
- Ohmori S, "Septic endophthalmitis and meningitis associated with Klebsiella pneumoniae liver abscess", Hepatol Res, 22, pp.307~312 (2002)
- Rahimian J, "Pyogenic liver abscess: recent trends in etiology and mortality", Clin Infect Dis, 39, pp.1654~1659 (2004)
- Lin JC, "High prevalence of phagocytic-resistant capsular serotypes of Klebsiella pneumoniae in liver abscess", Microbes Infect, 6, pp.1191~1198 (2004)
- Wiskur BJ, "Hypermucoviscosity as a virulence factor in experimental Klebsiella pneumoniae endophthalmitis", Invest Ophthalmol Vis Sci, 49, pp.4931~4938 (2008)
- Lin JC, "Impaired phagocytosis of capsular serotypes K1 or K2 Klebsiella pneumoniae in type 2 diabetes mellitus patients with poor glycemic control", J Clin Endocrinol Metab, 91, pp.3084~3087 (2006)