서부 경남지역 내인성 안내염의 임상양상과 예후
Clinical Characteristics and Prognosis of Endogenous Endophthalmitis in Western Gyeongsangnam-do
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목적: 서부 경남지역 내인성 안내염환자들을 후향적으로 분석하여 임상양상과 최종 시력과 연관된 예후인자를 분석하고자 하였다. 대상과 방법: 2007년 1월부터 2017년 12월까지 경상대학교병원에서 내인성 안내염으로 진단된 24명 33안의 의무기록을 후향적으로분석하였다. 결과: 대상 환자군의 평균 연령은 63.2세였으며, 남성이 58.3%였다. 24명 중 9명(37.5%)은 양안에 발생하였다. 간농양(30.3%)과 비뇨기계 감염(24.2%)이 가장 흔한 감염 병소였다. 72.7%에서 균 배양 결과 양성 소견을 보였으며, 가장 흔한 원인 균은 Gram-negative organisms (45.8%)이고, 그중 Klebsiella pneumoniae가 가장 흔히 동정되는 세균이었다. 유리체 흡인 및 유리체내 항생제 주입을모든 환자들에게 시행하였으며, 12안(36.4%)은 유리체절제술 및 유리체내 항생제주입술을 시행하였다. 안구적출 및 안구내용제거술이 6안(18.2%)에서 시행되었다. 초진시력이 안전수지 미만인 군이 그렇지 않은 군보다 최종 시력예후가 좋지 않았다(p=0.001). 결론: 내인성 안내염은 의학의 발전에도 불구하고 여전히 불량한 예후를 보였으며, 특히 초진시력이 좋지 않은 군이 예후가 좋지 않았다. 간농양과 비뇨기계 감염이 가장 흔한 감염 병소였으며, Klebsiella pneumoniae가 가장 흔한 원인 균이었다.
Abstract
Purpose: To investigate the clinical features and prognosis associated with endogenous endophthalmitis (EE) in western Gyeongsangnam-do over an 11-year period. Methods: This study was a retrospective review of the medical records of 24 patients (33 eyes) who presented with endogenous endophthalmitis at the Gyeongsang National University Hospital from 2007 to 2017. Results: The mean age of onset was 63.2 years, and 58.3% of the patients were men. Bilateral involvement was observed in nine patients (37.5%). Liver abscess (30.3%) and urinary tract infection (24.2%) were the most common extraocular sources of infection. Positive culture result was noted in 72.7% of the patients. The most common causative agents were gram-negative organisms (45.8%); the most commonly isolated microorganism was Klebsiella pneumoniae. Vitreous tapping and intravitreal antibiotic injection were performed in all patients; pars plana vitrectomy with intravitreal injection of antibiotics was performed in 12 eyes (36.4%). Enucleation and evisceration were performed in six eyes (18.2%). Initial visual acuity worse than hand motion was associated with a significantly worse visual outcome (p = 0.001). Conclusions: In our study, EE showed a poor visual prognosis, irrespective of treatment. Poor initial visual acuity was predictive of poor visual outcome. Liver abscess and urinary tract infections were common extraocular sources of EE and K. pneumoniae was the most common causative organism.
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