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.

作者：Kai-Yang Chen, Hoi-Chun Chan, Chi-Ming Chan · 发表于：Journal of Infection and Public Health · 年份：2025 · DOI：10.1016/j.jiph.2025.103090 · 被引用次数：11 · 研究领域：Medicine

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)...