Clinical and microbiological insights into endogenous endophthalmitis: A ten-year study highlighting mNGS efficacy

Endophthalmitis is an ophthalmic emergency. In recent years, the incidence of endogenous endophthalmitis (EE) has increased. This study aims to elucidate the clinical characteristics and risk factors associated with the visual prognosis of EE.

This study included 111 patients (121 eyes) diagnosed with EE who received intraocular and systemic treatment at Huashan Hospital, Fudan University, between January 2014 to December 2023. We conducted a comprehensive review of the demographic and clinical characteristics of the cohort and analyzed the risk factors linked to poor visual prognosis.

A total of 111 patients (121 eyes) were included in this study, of whom 101 eyes (83.5 %) had identifiable pathogenic microorganisms, with Klebsiella pneumoniae (KP) was the most common pathogen. Compared to conventional culture methods (sensitivity 47.6 %), metagenomic next-generation sequencing (mNGS) demonstrated significantly higher sensitivity (97.6 %) in vitreous samples. Outcome analysis indicated that mNGS played a critical role in guiding clinical antibiotic adjustments, and patients receiving targeted therapy showed significant visual improvement (P = 0.002), with stable systemic recovery. Furthermore, vitreous surgery had a positive effect on visual prognosis (P < 0.001). Regression analysis revealed that poor initial visual acuity (VA) (OR: 20.622, 95 % CI: 3.894-109.2) and KP infection (OR: 3.398, 95 % CI: 1.096-10.538) were independent risk factors for poor final VA.

Our findings identify KP as the most common causative pathogen of EE. Infections caused by KP and poor initial VA are significant risk factors for poor visual outcomes. Looking ahead, mNGS holds promise as a crucial tool for the clinical diagnosis of EE.