Prognostic Factors and Outcomes in Endogenous Klebsiella pneumoniae Endophthalmitis

PURPOSE: To determine risk factors for poor visual acuity outcomes in patients with endogenous Klebsiella pneumoniae endophthalmitis. DESIGN: Retrospective case-control study. METHODS: We reviewed all consecutive patients diagnosed with endogenous Klebsiella pneumoniae endophthalmitis over 20 years. Data collected included patients' demographics, clinical findings, investigations, and therapeutic intervention. Main outcome measures were visual acuity (VA) at 3 months postinfection and/or evisceration. Poor vision was defined as VA worse than 4/200. RESULTS: Seventy-one eyes of 61 patients were studied. Mean age was 55.7 (standard deviation [SD] +/- 13.1) years. Majority were male (49/61, 80.3%), Chinese (51/61, 83.6%), and had hepatobiliary sepsis (47/61, 77.5%). Mean time to ocular symptoms was 4.4 (+/- 3.0) days. Fifty-four of 71 eyes (80.2%) had poor vision and 19/71 eyes (26.8%) required evisceration. The most significant risk factor was hypopyon (41/71 eyes, 57.7%) on multivariate analysis (odds ratio [On 52.6; 95% confidence interval [CI], 1.7-1000; P = .01). Unilateral involvement (OR, 10.4; 95% Cl, 1.2-90.2; P = .01) and patients that were managed before year 2000 (before routine screening was implemented) (OR, 5.2; 95% CI, 1.5-17.9; P = .037) were significant risk factors for evisceration on multivariate analysis. CONCLUSION: Patients presenting with hypopyon and unilateral involvement have a poorer prognosis. (Am J Ophthalmol 2011;151:338-344. (C) 2011 by Elsevier Inc. All rights reserved.)