Ophthalmology Department, Cochin Port Royal University Hospital AP-HP, Paris, France.
Infectious Diseases Stewardship Unit, Cochin Port Royal University Hospital AP-HP, Paris, France; Hematology department, CH Annecy Genevois, France.
Int J Infect Dis. 2024 Sep;146:107116. doi: 10.1016/j.ijid.2024.107116. Epub 2024 May 26.
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.
Retrospective case series in two tertiary referral centers from 2010 to 2022.
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).
EE remains a severe infection with a poor ocular outcome. We propose a standard protocol to improve diagnosis and medical management.
描述内生性眼内炎（EE）患者的临床和微生物学特征，确定与结局相关的因素，并提出 EE 的治疗方案。
回顾性病例系列研究，纳入 2010 年至 2022 年在两家三级转诊中心就诊的 53 例（64 只眼）患者。
53 例患者中，11 例（21%）为双眼受累。36 例（68%）患者以眼部症状为首发表现，17 例（32%）患者出现败血症表现。34 例（64%）患者至少有一处眼外感染灶在影像学检查中被发现，其中 28 例（56%）患者的增强胸腹部计算机断层扫描有相关发现。53 例（81%）患者的 EE 经微生物学证实，病原体包括：革兰阳性菌（19/53，36%）、革兰阴性菌（13/53，25%）和念珠菌（11/53，21%）。肺炎克雷伯菌是最常见的细菌（10/32，31%）。53 例（53%）患者的血培养阳性，41 只眼中的 11 只（27%）眼内样本阳性。所有患者均接受全身抗菌治疗，39 只眼（61%）接受抗感染眼内注射，17 只眼（27%）行玻璃体切除术。4 例（8%）患者因全身感染失控而死亡。57 只眼中，最终视力（VA）<20/400 的有 28 只（49%），64 只眼中眼结构丧失（眼球萎缩或眼球摘除/眼内容剜除）的有 18 只（28%）。多因素分析显示，初始 VA 是与视力和/或眼部结构丧失相关的唯一参数（分别为 24.44（4.33-228.09）和 5.44（1.33-26.18））。
EE 仍是一种严重的感染，眼部预后不良。我们提出了一个标准方案，以改善诊断和医疗管理。
