The following is a summary of “Endogenous endophthalmitis: new insights from a 12-year cohort study,” published in the May 2024 issue of Infectious Disease by Dedieu et al.

Researchers conducted a retrospective study to characterize the clinical presentation, identify microbial culprits, evaluate prognostic factors, and optimize a management strategy for endogenous endophthalmitis (EE). 

They conducted a comprehensive review of medical records from all patients diagnosed with EE at two Parisian tertiary academic centers, Cochin Port Royal Hospital and Hôtel-Dieu Hospital, over a 12-year period, from January 2010 to April 2022.

The results showed data from 64 eyes of 53 patients with endogenous endophthalmitis. Both eyes were affected in over 11 of 53 cases (21%). Notably, nearly 36 (68%) cases presented with only eye symptoms initially, while the remaining 17 (32%) showed signs of systemic infection first. Imaging techniques identified potential infection sources outside the eye in over 34 (60%) patients, with CT scans particularly helpful in 28 (56%). Microbiological testing confirmed the cause of infection in 43(81%) of cases, with bacteria being the most common cases: gram-positive 19(36%), gram-negative 13(25%), and Candida 11(21%). Klebsiella pneumoniae was the most frequent bacterial culprit 10(31%). Blood cultures identified the organism in over 28(53%) patients, while eye samples were positive in 11(27%). All patients received systemic antibiotics 39, and a significant portion (61%) also received anti-infective intravitreal injection directly into the eye. In more severe cases, 17 (27%), surgery inside the eye (vitrectomy) was necessary, 8% of patients succumbed to the underlying systemic infection. The final visual acuity was less than 20 for nearly half of 28(49%) cases, and almost a third, 18(28%), experienced severe eye damage requiring removal of the eyeball (bulbar phthisis/enucleation/evisceration). Interestingly, only initial visual acuity significantly predicted both vision loss and structural damage in a more detailed analysis (OR = 24.44 (4.33-228.09) and 5.44 (1.33-26.18), respectively).

Investigators concluded that given the substantial vision loss associated with endogenous endophthalmitis, this study advocates for a standardized approach to improve diagnostic accuracy and guide optimal treatment.

Source: ijidonline.com/article/S1201-9712(24)00187-5/fulltext#%20