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Case Report of Catheter-Related Klebsiella Pneumoniae Endophthalmitis.

BACKGROUND
Endogenous endophthalmitis (EE) is a severe sight-threatening ocular infection caused by a variety of microbes. Here, we report a rare case of Endogenous Klebsiella pneumoniae endophthalmitis (EKPE) related to Klebsiella pneumonia (Kp) from a catheter.


METHODS
A 76-year-old man suffered bacteremia one month after a right internal jugular venous catheter was administered due to the need of parenteral nutrition after pancreatoduodenectomy. The results of catheter tip culture and blood culture indicated that he had extended-spectrum β-lactamases (ESBL) (+) Kp. One month after recovery, the patient had a high fever that was accompanied by a sudden loss of vision in his left eye. ESBL (+) Kp was found in the vitreous fluid and blood.


RESULTS
The patient was diagnosed with EKPE. The patient underwent three-port pars plana vitrectomy (PPV) in the left eye, biapenem was administered intravenously for four weeks. One week after the withdrawal of the biapenem, the patient's right neck was palpated with a strip-shaped mass of about 10.0 cm x 5.0 cm. Incision and drainage of the right neck abscess was performed. ESBL (+) Kp was found in the abscess of the neck cultures. Imipenem/cilastatin and ciprofloxacin were administered post-operation and gradually changed to ceftazidime. Amoxicillin/clavulanate potassium and levofloxacin were administered to the patient after being discharged from hospital. During the follow-up, the patient recovered from the bacteremia but still had no light perception in his left eye.


CONCLUSIONS
A patient with a Kp infection and blurred vision should have ocular examination especially for patients with diabetes.