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Meta-Analysis
. 2026 Mar;19(3):103090.
doi: 10.1016/j.jiph.2025.103090. Epub 2025 Dec 5.

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

Kai-Yang Chen  1 , Hoi-Chun Chan  2 , Chi-Ming Chan  3
Affiliations
Free article
Meta-Analysis

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

Kai-Yang Chen et al. J Infect Public Health. 2026 Mar.
Free article

Abstract

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).

Conclusions: EE is a devastating complication of KP-PLA, particularly in diabetic patients infected with hvKP. Early recognition of at-risk patients and prompt intervention, including early vitrectomy, are crucial to improve visual outcomes. These findings highlight the clinical importance of hvKP in the pathogenesis of EE and reinforce the need for vigilant ophthalmic monitoring in KP-PLA cases.

Keywords: Diabetes Mellitus; Endogenous Endophthalmitis; Hypervirulent; Klebsiella pneumoniae; Pyogenic Liver Abscess; Visual Outcome.

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Conflict of interest statement

Declaration of Competing Interest The authors declare no conflicts of interest related to this study. The research was conducted independently, without any financial or personal relationships that could influence the work reported in this manuscript. No funding from pharmaceutical companies or other entities with vested interests was received. All authors affirm that the findings and conclusions are solely their own and are not influenced by external interests.

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