Risk factors for endogenous Klebsiella endophthalmitis in patients with Klebsiella bacteraemia:: A case-control study

Aim: To identify risk factors for Klebsiella endophthalmitis in patients with Klebsiella sepsis. Methods: This is a retrospective case-control study. The study population consisted of all patients with positive blood cultures for Klebsiella, admitted to Changi General Hospital (Singapore) from August 2004 to July 2005. The cases were patients who developed Klebsiella endophthalmitis, and the controls were those who did not. The potential risk factors analysed included age, sex, race and total white cell count at presentation, maximum temperature response, co-morbid pathologies, presence of severe infection, site of primary infection, antibiotic sensitivity of the bacterial strain, and systemic antibiotics treatment regimen. Results: 133 consecutive patients with Klebsiella bacteraemia confirmed by blood culture were included. Five (3.8%) developed endophthalmitis. Klebsiella endophthalmitis was significantly associated with liver abscess as the primary site of infection (p<0.001) and disseminated intravascular coagulation (p=0.010) on both univariate and multivariate analysis. Diabetes mellitus and other co-morbid pathologies, race and maximum temperature response were not risk factors for the occurrence of endophthalmitis. Conclusions: Liver abscess and disseminated intravascular coagulation are risk factors for endogenous endophthalmitis in patients with Klebsiella sepsis.