The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Klebsiella pneumoniae as the Most Frequent Pathogen of Endogenous Endophthalmitis

내인성 내안구염의 가장 흔한 원인 균주로서의 Klebsiella pneumoniae

  • Park, Ga-Young (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Kim, Shin-Woo (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Kim, Hye-In (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Kwon, Eu-Gene (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Kim, Hyo-Hoon (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Jeong, Ju-Young (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Chang, Hyun-Ha (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Lee, Jong-Myung (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Kim, Nung-Soo (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Lee, Shin-Won (Department of Internal Medicine, Daegu Fatima Hospital) ;
  • Ryu, Seong-Yeol (Department of Internal Medicine, Keimyung University School of Medicine)
  • 박가영 (경북대학교 의학전문대학원 내과학교실) ;
  • 김신우 (경북대학교 의학전문대학원 내과학교실) ;
  • 김혜인 (경북대학교 의학전문대학원 내과학교실) ;
  • 권유진 (경북대학교 의학전문대학원 내과학교실) ;
  • 김효훈 (경북대학교 의학전문대학원 내과학교실) ;
  • 정주영 (경북대학교 의학전문대학원 내과학교실) ;
  • 장현하 (경북대학교 의학전문대학원 내과학교실) ;
  • 이종명 (경북대학교 의학전문대학원 내과학교실) ;
  • 김능수 (경북대학교 의학전문대학원 내과학교실) ;
  • 이신원 (대구파티마병원 내과) ;
  • 류성열 (계명대학교 의과대학 내과학교실)
  • Published : 2012.02.01
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Abstract

Background/Aims: Endogenous endophthalmitis (EE) is rare. However, the visual outcome of patients with EE is very poor. Many cases of EE caused by Gram-negative bacterial infections have recently been reported. This study was conducted to explore the most frequent pathogens, diagnosis, and treatment outcomes of EE. Methods: A retrospective analysis was carried out in 23 patients diagnosed with EE through clinical manifestations and ophthalmic examinations in three hospitals between January 2000 and April 2011. Samples from 23 patients with EE were analyzed microbiologically. Results: Pathogens were identified in 18 (78%) of the 23 blood, liver aspirate, and/or vitreous humor samples. Klebsiella pneumoniae was the most frequent organism (13/23, 57%). Abdomino-pelvic imaging (21/23, 91%) was performed to evaluate the primary site of infection. The most common primary infection was liver abscess (14/23, 61%). Despite administration of intravenous antibiotics and intravitreal injection, only six of 23 patients showed improvements in visual acuity. Thirteen (57%) experienced worse visual acuity. Four (17%) were eventually enucleated. Conclusions: In patients diagnosed with EE, abdomino-pelvic CT is required to exclude the presence of liver abscess. If a liver abscess is identified, percutaneous drainage should be considered. Considering the rapid progression and poor prognosis of EE, early diagnosis and immediate management are vital. We currently suggest that empiric antibiotics for treatment of EE should have activity against Gram-negative bacilli such as K. pneumoniae.

목적: 내인성 내안구염은 드물지만 예후가 좋지 않은 질환으로 알려져 있다. 최근 내인성 내안구염에서 그람양성균 보다 그람음성균이 주요 원인균으로 나타나고 있는 것이 경험되고 있고 이에 대한 증례 보고들이 있어 내안구염의 주요 원인균과 진단, 그 예후에 대해 알아보고자 하였다. 방법: 2000년부터 2011년까지 총 3개 병원에서 내인성 내안구염이 총 23명의 환자에서 진단되었으며 이들은 환자의 임상증상과 징후 및 안과적 조사를 통해서 진단되었다. 환자의 안과적 수술 및 시술 시의 안구 검체 배양 및 혈액배양, 농배양 등을 통해 원인균을 확인하였으며 전체 환자에서 원발 감염의 원인 조사를 위한 복부전산화단층촬영이 시행되었다. 예후는 안과적 시력추적을 통해 확인하였다. 결과: 전체 23명의 환자 중에서 총 18명(78%)의 환자에서 혈액, 농, 눈 등에서 원인균이 동정되었다. 가장 흔한 원인균 주는 Klebsiella pneumoniae로 14명(61%)의 환자에서 동정되었다. 복부전산화단층촬영에서 23명의 환자 중 14명(61%)의 환자에서 간농양 소견이 보였다. 치료에도 불구하고 23명의 환자 중 6명만이 시력의 호전을 보였으며 13명에서는 시력이 나빠지는 결과를 보였다. 그중 4명에서는 안구적출술을 시행하였다. 결론: 내인성 내안구염의 원인균으로 K. pneumoniae가 가장 흔하게 나타났으며 간농양이 가장 흔한 원발 감염으로 보인다. 따라서 내인성 내안구염으로 진단받은 환자에서 원발감염에 대한 조사로서 복부전산화단층촬영 등을 시행하고 간농양을 확인하고 필요 시 배농이 필요할 것으로 생각되었다. 내인성 내안구염의 빠른 경과와 나쁜 예후를 볼 때 빠른 진단 및 안과적 처치가 필요하며 항생제의 선택 시 K. pneumoniae 등의 그람음성균에 대한 치료 약제가 선택되어야 할 것으로 생각된다.

Keywords

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