How does hypervirulent Klebsiella pneumoniae influence the risk and visual outcomes of endogenous endophthalmitis in Klebsiella pneumoniae pyogenic liver abscess? A systematic review and meta analysis
Year: 2025
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: BACKGROUND: Klebsiella pneumoniae pyogenic liver abscess (KP-PLA) is increasingly recognized as a cause of endogenous endophthalmitis (EE), particularly in East and Southeast Asia. Hypervirulent K. pneumoniae (hvKP) strains have been implicated in severe ocular complications, yet comprehensive data on incidence, risk factors, and visual outcomes are limited. METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines. We searched PubMed, Google Scholar, Cochrane Library, Science Direct for studies reporting KP-PLA-associated EE up to March 2025. Data on patient demographics, comorbidities, microbiological features, treatments, and visual outcomes were extracted. Pooled event rates and odds ratios (OR) with 95 % confidence intervals (CI) were calculated using random-effects models. RESULTS: Seventeen studies encompassing 219 patients met inclusion criteria. Diabetes mellitus was common among KP PLA associated EE cases (pooled event rate 0.674; 95 % CI: 0.585-0.751; p < 0.001). hvKP strains, identified by positive string tests and virulence genes including rmpA, magA, and aerobactin, predominated in EE cases. Regional differences were observed, with higher prevalence in East and Southeast Asia. Despite aggressive systemic and ocular treatment, visual prognosis was poor: 77.9 % of patients had final visual acuity worse than 3/60. Early pars plana vitrectomy with silicone oil tamponade was associated with fewer postoperative interventions (p < 0.05). CONCLUSIONS: EE is a devastating complication of KP-PLA, particularly in diabetic patients infected with hvKP. Early recognition of at-risk patients and prompt intervention, including early vitrectomy, are crucial to improve visual outcomes. These findings highlight the clinical importance of hvKP in the pathogenesis of EE and reinforce the need for vigilant ophthalmic monitoring in KP-PLA cases.
Authors: Kai-Yang Chen, Hoi-Chun Chan, Chi-Ming Chan
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,310
Awards: G1692680486, The Roles of Cask in Retinopathy: Molecular Mechanisms in Regulating Retinal Pigment Epithelial Cells and Müller Cell Death and Inflammation, G7994595302, The Roles of Cask in Diabetic Retinopathy: Mechanisms in Regulating Methylglyoxal Induced Cell Death and Inflammation in Retinal Müller Cells and Pigment Epithelial Cells( I )
OpenAlex ID: W4417049859