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Related Experiment Video

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Gram-Negative Endogenous Endophthalmitis: A Systematic Review.

Giorgio Tiecco1, Davide Laurenda1, Alice Mulè1

  • 1Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy.

Microorganisms
|January 21, 2023
PubMed
Summary

Gram-negative bacteria cause endogenous endophthalmitis (EBE), often linked to diabetes and liver abscesses. This review highlights poor visual outcomes and the need for prompt ocular evaluation in Gram-negative infections.

Keywords:
EBEEscherichia coliGram-negativeKlebsiellaPseudomonasendogenous bacterial endophthalmitisendogenous endophthalmitisendophthalmitisreviewsystematic review

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Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Microbiology

Background:

  • Endogenous endophthalmitis (EBE) is frequently caused by Gram-negative bacteria.
  • Understanding the specific pathogens, risk factors, and early ocular manifestations is crucial for timely diagnosis and management.
  • This systematic review addresses the current literature on Gram-negative EBE.

Purpose of the Study:

  • To systematically review and synthesize data on the aetiologies, risk factors, and early ocular lesions associated with Gram-negative EBE.
  • To identify common causative organisms, predisposing conditions, and initial clinical presentations.
  • To evaluate treatment modalities and visual outcomes in patients with Gram-negative EBE.

Main Methods:

  • A comprehensive literature search was conducted on PubMed and Cochrane Controlled Trials for peer-reviewed articles published between January 2002 and August 2022.
  • Studies focusing on Gram-negative EBE were included.
  • Data extraction and synthesis were performed on 115 studies involving 591 patients.

Main Results:

  • The most common Gram-negative aetiologies were *Klebsiella pneumoniae* (66.1%) and *Pseudomonas aeruginosa* (14.4%), with diabetes (55%) being a frequent comorbidity.
  • Liver abscesses (54.5%) were the predominant source of infection, leading to ocular manifestations like vitreal opacity (49.6%) and hypopyon (35.2%).
  • Treatment involved various antibiotics (ceftriaxone, fluoroquinolones, ceftazidime) and surgical interventions (vitrectomy, evisceration), with a high rate of poor visual acuity (no light perception in 55.2% at discharge).

Conclusions:

  • Gram-negative EBE is associated with severe visual impairment and poor prognoses.
  • The review, primarily based on case reports and series, highlights significant heterogeneity but provides a large sample size over two decades.
  • These findings emphasize the critical need to consider ocular involvement in patients with systemic Gram-negative infections.