1. Endogenous endophthalmitis: New insights from a 12-year cohort study.
- Author
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Dedieu D, Contejean A, Gastli N, Marty-Reboul J, Poupet H, Brezin A, Monnet D, Charlier C, and Canouï E
- Subjects
- Humans, Male, Female, Retrospective Studies, Middle Aged, Aged, Adult, Aged, 80 and over, Eye Infections, Bacterial diagnosis, Eye Infections, Bacterial microbiology, Eye Infections, Bacterial drug therapy, Vitrectomy, Young Adult, Endophthalmitis microbiology, Endophthalmitis diagnosis, Endophthalmitis drug therapy, Endophthalmitis therapy, Anti-Bacterial Agents therapeutic use
- Abstract
Objectives: To describe the clinical and microbiological characteristics of patients with endogenous endophthalmitis (EE), determine factors associated with outcome and propose a management plan for EE., Methods: Retrospective case series in two tertiary referral centers from 2010 to 2022., Results: Sixty-four eyes of 53 patients were included. Bilateral involvement occurred for 11/53 patients (21%). Ocular symptoms were the only first manifestation of the disease in 36/53 (68%) of cases; signs of sepsis were evident in 17/53 (32%). Imaging tests detected at least one extraocular focus of infection in 34/53 patients (64%), with contrast-enhanced thoraco-abdominopelvic computed tomography showing relevant findings in 28/50 (56%) of cases. EE was microbiologically confirmed in 43/53 patients (81%); the organisms involved were: Gram-positive bacteria (19/53, 36%), Gram-negative bacteria (13/53, 25%) and Candida sp. (11/53, 21%). Klebsiella pneumoniae was the most common bacteria (10/32, 31%). Blood cultures were positive in 28/53 patients (53%) and eye samples in 11/41 eyes (27%). All patients were treated with systemic antimicrobial therapy, 39/64 eyes (61%) received anti-infective intravitreal injection(s) and 17/64 eyes (27%) underwent vitrectomy. Four patients (8%) died due to uncontrolled systemic infection. Final visual acuity (VA) was < 20/400 in 28/57 eyes (49%) and ocular structural loss (bulbar phthisis or enucleation/evisceration) was reported in 18/64 eyes (28%). In multivariate analysis, initial VA was the only parameter associated with visual and/or structural loss of the eye (OR = 24.44 (4.33-228.09) and 5.44 (1.33-26.18) respectively)., Conclusions: EE remains a severe infection with a poor ocular outcome. We propose a standard protocol to improve diagnosis and medical management., Competing Interests: Declarations of competing interest The authors have no competing interests to declare that are relevant to the content of this article. The authors declare they have no financial interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2024
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