Routine ophthalmologic examination in Klebsiella pneumoniae bacteremia is not necessary: incidence of and risk factors for ocular involvement

• Published in: Antimicrobial agents and chemotherapy 2023-11, Vol.67 (11), p.e0082223-e0082223
• Main Authors: Lim, So Yun, Kwon, Hye Ji, Lee, Yun Woo, Sung, Heungsup, Kim, Mi-Na, Chang, Euijin, Bae, Seongman, Jung, Jiwon, Kim, Min Jae, Kim, Sung-Han, Choi, Sang-Ho, Lee, Sang-Oh, Kim, Yang Soo, Lee, Joo Yong, Chong, Yong Pil
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Bacteremia - epidemiology; Chorioretinitis - complications; Chorioretinitis - drug therapy; Endophthalmitis - drug therapy; Endophthalmitis - epidemiology; Humans; Incidence; Klebsiella Infections - drug therapy; Klebsiella Infections - epidemiology; Klebsiella pneumoniae; Liver Abscess - drug therapy; Retrospective Studies; Risk Factors
• ISSN: 0066-4804; 1098-6596
• DOI: 10.1128/aac.00822-23

bacteremia is known to present a virulent clinical course, including multiple metastatic infections, which is not uncommon in Asia. However, there are limited data on the incidence and risk factors for ocular involvement in bacteremia. We retrospectively reviewed the medical records of all patients with bacteremia who underwent ophthalmologic examination in a tertiary center in Seoul, Korea, from February 2012 to December 2020. Two retinal specialists reviewed the findings of the ophthalmologic examinations and classified them as endophthalmitis, chorioretinitis, and no ocular involvement. Of 689 patients, 56 [8.1%; 95% confidence interval (CI) 6.2-10.4] had ocular involvement, and 9 (1.3%; 95% CI 0.6-2.5) were diagnosed with endophthalmitis. Of 47 patients with chorioretinitis, 45 (95.7%) improved with systemic antibiotic therapy alone. Community-onset bacteremia (100% vs 62.1% vs 57.4%, = 0.04), cryptogenic liver abscess (55.6% vs 11.8% vs 8.5%, = 0.003), and metastatic infection (66.7% vs 5.8% vs 10.6%, < 0.001) were more common in endophthalmitis than in no ocular involvement or chorioretinitis. In the multivariable analysis, cryptogenic liver abscess [adjusted odds ratio (aOR), 6.63; 95% CI 1.44-35.20] and metastatic infection (aOR, 17.52; 95% CI 3.69-96.93) were independent risk factors for endophthalmitis. Endophthalmitis was not associated with 30-day mortality. Endophthalmitis is rare in Asian patients with bacteremia. Targeted ophthalmologic examination in those with cryptogenic liver abscess, metastatic infection, or ocular symptoms may be more appropriate than routine examination of all patients.