Elsevier

Ophthalmology

Volume 119, Issue 11, November 2012, Pages 2358-2363
Ophthalmology

Original article
A One-Year Follow-up Study on the Incidence and Risk of Endophthalmitis after Pyogenic Liver Abscess

https://doi.org/10.1016/j.ophtha.2012.05.022Get rights and content

Purpose

Although endophthalmitis secondary to pyogenic liver abscess (PLA) is becoming a globally emerging infectious disease, population-based investigations evaluating the relationship between PLA and endogenous endophthalmitis remain scarce. This study aimed to investigate the incidence and risk of endogenous endophthalmitis in patients with PLA compared with unaffected individuals by using a nationwide, population-based dataset.

Design

Retrospective, cohort study.

Participants and Controls

This study used data sourced from Taiwan's National Health Insurance Research Database. In total, 12 727 patients with PLA were included in the study group and 63 635 matched subjects were randomly extracted as a comparison group.

Methods

Stratified Cox proportional hazards regressions were performed to assess the effect of PLA on the hazard of developing endogenous endophthalmitis.

Main Outcome Measures

The incidence and risk of endogenous endophthalmitis between the study group and comparison group.

Results

Of the total sample, 148 subjects (0.10%) were diagnosed with endophthalmitis during the 1-year follow-up period. Endophthalmitis was found in 106 patients (0.84%) with PLA and 42 comparison patients (0.07%). After adjusting for patient monthly income, geographic location, and urbanization level, those suffering from PLA were found to have a greater likelihood of developing endophthalmitis during the 1-year follow-up period than comparison patients (hazard ratio [HR], 12.83; 95% confidence interval, 8.94–18.41). Stratification did not reveal any large differences in the adjusted HRs for endophthalmitis between PLA patients suffering from diabetes and those in whom diabetes was absent. We further analyzed the etiology of cases with endogenous endophthalmitis in this investigation and found Klebsiella pneumonia to be the causative organism among 75.5% of the cases but only 33.4% of the comparison group.

Conclusions

We found that the incidence and risk of developing endophthalmitis was significantly higher among patients with PLA compared with matched controls irrespective of diabetes status.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Section snippets

Database

This study used data sourced from Taiwan's National Health Insurance Research Database (NHIRD), which is derived from the Taiwan National Health Insurance program and maintained by the National Health Research Institute. Each year, the National Health Research Institute collects data from the National Health Insurance program and sorts it into data files, including registration files and original claim data for reimbursement. As of 2007, the NHIRD covers registrations files and the medical

Results

Table 1 presents the demographic characteristics and comorbid medical disorders for the patients with PLA and comparison subjects analyzed in this study. This investigation included 76 362 subjects, whose mean age (±SD) was 62.2 (±15.2) years and >61.5% of whom were males. We found K pneumoniae (ICD-9-CM code 041.3) to be the causative organism among 73.2% of the patients with PLA. In addition, about 40% of sampled subjects had diabetes. After matching for age, gender, and diabetes status,

Discussion

The relationship between PLA and subsequent endogenous endophthalmitis has long been a topic of interest among researchers. Because endogenous endophthalmitis is a rare disease, only case reports and case series have been used to characterize it to date.16, 19, 23, 28 To the best of our knowledge, this is the first population-based study to investigate the epidemiologic association between PLA and endogenous endophthalmitis. In our study, about 0.84% of the patients with PLA subsequently

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    Manuscript no. 2012-177.

    Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

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