Korean J Intern Med.  2015 Jul;30(4):453-459. 10.3904/kjim.2015.30.4.453.

Prevalence of and risk factors for endogenous endophthalmitis in patients with pyogenic liver abscesses

• Park IH
• Jun CH
• Wi JW
• Park SY
• Lee WS
• Jung SI
• Park CH
• Joo YE
• Kim HS
• Choi SK
• Rew JS

• KMID: 2366005
• DOI: http://doi.org/10.3904/kjim.2015.30.4.453

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.

Keyword

Endophthalmitis; Liver abscess; Klebsiella pneumonia; Risk factors

MeSH Terms

Aged
Anti-Bacterial Agents/administration & dosage
Chi-Square Distribution
Early Diagnosis
Endophthalmitis/diagnosis/*epidemiology/microbiology/therapy
Female
Humans
Intravitreal Injections
Liver Abscess, Pyogenic/diagnosis/*epidemiology/microbiology
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Predictive Value of Tests
Prevalence
Republic of Korea/epidemiology
Retrospective Studies
Risk Factors
Tomography, X-Ray Computed
Treatment Outcome
Visual Acuity
Vitrectomy
Anti-Bacterial Agents