214. Routine Ophthalmologic Examination in Klebsiella pneumoniae Bacteremia Is Not Necessary: Incidence of and Risk Factors for Ocular Involvement
Authors: Yun Lim So , Ji Kwon Hye , Woo Lee Yun , Sung Heungsup , Kim Mi-Na , Jin Chang Eui , Bae Seongman , Jung Jiwon , Jae Kim Min , Kim Sung-Han , Choi Sang-Ho , Lee Sang-Oh , Soo Kim Yang , Yong Lee Joo , Pil Chong Yong 
Published: November 2023

Abstract

Background
Klebsiella pneumoniae bacteremia can result in severe clinical manifestations including metastatic infection, which is not uncommon in Asia. However, there are limited data on the incidence and risk factors for ocular involvement in K. pneumoniae bacteremia.

Methods
We retrospectively reviewed the medical records of all patients with K. pneumoniae bacteremia who underwent ophthalmologic examination in a tertiary center in Seoul, Korea, from February 2012 to December 2020. Two retinal specialists reviewed the findings of the ophthalmologic examinations and classified them as endophthalmitis, chorioretinitis, and no ocular involvement.

Results
Of 689 patients, 56 (8.1%; 95% CI 6.2-10.4) had ocular involvement, and 9 (1.3%; 95% CI 0.6-2.5) were diagnosed with endophthalmitis. Of 47 patients with chorioretinitis, 45 (95.7%) improved with systemic antibiotic therapy alone. Community-onset bacteremia (100% vs 62.1% vs 57.4%, P=0.04), cryptogenic liver abscess (55.6% vs 11.8% vs 8.5%, P=0.003), and metastatic infection (66.7% vs 5.8% vs 10.6%, P &lt; 0.001) were more common in endophthalmitis than in no ocular involvement or chorioretinitis. In multivariable analysis, cryptogenic liver abscess (aOR, 6.63; 95% CI, 1.44-35.20) and metastatic infection (aOR, 17.52; 95% CI, 3.69-96.93) were independent risk factors for endophthalmitis. Endophthalmitis was not associated with 30-day mortality.Table 1.Demographics, clinical characteristics and outcomes of patients with K. pneumoniae bacteremia according to degree of ocular involvement
Data presents n (%) unless indicated otherwise. aNo significant difference (P&gt;0.017) between any of the pairs in post hoc analysis. bWithin 1 month. cDefined as one of the following conditions: (i) daily receipt of immunosuppressants including corticosteroids, (ii) human immunodeficiency virus infection, (iii) solid organ or hematopoietic stem cell transplant recipients, (iv) receipt of chemotherapy for underlying malignancy during the previous 6 months, and (v) underlying immune deficiency disorder. dDose equivalent to ≥20mg/day of prednisone for two weeks or longer. eSignificantly different (P &lt;0.017) between endophthalmitis and no ocular involvement. fSignificantly different (P &lt;0.017) between endophthalmitis and chorioretinitis. gMetastatic infection other than ocular involvement. hSignificantly different (P &lt;0.017) between chorioretinitis and no ocular involvement.Table 2.Risk factors for endophthalmitis in patients with K. pneumoniae bacteremiaaMetastatic infection other than ocular involvement.Table 3.Risk factors for 30-day mortality in patients with K. pneumoniae bacteremiaaThird-generation cephalosporin-resistant or carbapenem-resistant

Conclusion
Endophthalmitis is rare in Asian patients with K. pneumoniae bacteremia. Targeted ophthalmologic examination in those with cryptogenic liver abscess, multiple metastatic infections, or ocular symptoms may be more appropriate than routine examination of all patients.

Disclosures
All Authors: No reported disclosures