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Successful Treatment of Endogenous Klebsiella Pneumoniae Endophthalmitis Associated with Early Vitrectomy and Systemic Levofloxacin: A Case Report
以早期玻璃體切除術及全身性投予Levofloxacin成功治療內生性克雷白氏肺炎菌引起之眼內炎：案例報告
摘要
目的：內生性克雷白氏蘭引起之眼內炎一般預後都很差。我們報告一個由肝膿瘍引起此疾病的案例治療成功的經驗。方法：案例報告。結果：53歲男性，患有糖尿病，罹患肝膿瘍及克雷白氏菌菌血症而住院，右眼在發病三天後產生內生性眼內炎，最佳矯正視力為辨手指數80公分，診斷後立刻給予Vancomycin及Ceftazidime玻璃體內注射，隔天並進行玻璃體切除手術。抗生素的治療除了全身性投予Ceftriaxone之外，另外還給予總共兩周的口服Levofloxacin治療，在第一次手術之後的一個禮拜再度給予玻璃體內注射抗生素，第三個禮拜進行了第二次的玻璃體切除術。經過上述的治療之後，病患的眼內感染完全獲得控制，眼內發炎完全消失，只剩局部視網膜下的瘢痕殘留，而最後的最佳矯正視力可達0.3。結論：及早診斷並治療對於內生性克雷白氏菌引起之眼內炎的處理至關重要。Levof1oxacin被認為有良好的眼球內滲透性，口服Levof1oxacin對於控制克雷白氏菌的眼內感染可能有幫助。
關鍵字
無資料並列摘要
Purpose: The prognosis of Endogenous Klebsiella Pneumoniae (K.P.) endophthalmitis is generally poor. We report our successful experience in the treatment of this disease in a patient with liver abscess. Method: Case report. Results: A 53-year-old man, who had underline diabetes mellitus, suffered from liver abscess with K.P. bacteremia. Endogenous endophthalmitis in OD developed 3 days later. Initial best corrected visual acuity (BCVA) was counting finger 80cm. Immediate intravitreal injection (IVI) of vancomycin and ceftazidime was given, pars plana vitrectomy (PPV) was done on the next day. In addition to systemic use of cefrtiaxone (Rocephin), oral levofloxacin was also given for total 2 weeks. Repeated IVI of ceftazidime and second PPV were done 1 week and 3 weeks after the first surgical intervention. The disease was under control with above treatment. Intraocular inflammation completely subsided with only localized subretinal scar left. Visual outcome (BCVA: 0.3) was good. Conclusion: Early intervention is crucial in the management of endogenous K.P endophthalmitis. Oral levofloxacin, which is thought to have good intraocular penetration, may possibly have additional benefits to control the intraocular K.P infection.
延伸閱讀
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