Endogenous Endophthalmitis Incidence Increasing, Immunocompromised Most at Risk

Endogenous Klebsiella Endophthalmitis
Endogenous klebsiella endophthalmitis (EKE).
Pneumonia and renal/urinary tract infections predicted both higher hospital admission and mortality rates for individuals with endogenous endophthalmitis.

Endogenous endophthalmitis (EE) is increasing in incidence throughout the US, according to a study published in Eye. Pneumonia and renal and urinary tract infections (UTI), in particular, have led to increased mortality and hospital admission.

Researchers conducted a cross-sectional analysis of 6400 patients (median age 62 years, 55.4% women) with EE using the Nationwide Emergency Department (NEDS) Database from 2006-2017. They evaluated incidence rates, mortality rates, and demographic risk factors for patients diagnosed with both endophthalmitis and septicemia.  

The team noted that mortality increased from 8.6% (95% CI, 3.8–18.3%) in 2006 to 13.8% (95% CI, 9.7–19.2%) in 2017 (P =.94). Overall, most patients were women, in the bottom 25% income earning bracket (29.3%), and living in the south (40.5%).

Investigators identified factors associated with increased mortality, increased hospital admission, and both. Factors associated with increased mortality included human immunodeficiency virus infection/immune deficiencies (OR: 2.58; 95% CI, 1.26–5.28), heart failure (OR: 2.12; 95% CI, 1.47–3.05), and hepatic infections/cirrhosis (OR: 1.89; 95% CI, 1.28–2.79). Researchers determined that older age and intravenous drug use predicted admission. They found that pneumonia and renal/urinary tract infections (UTI) were associated with both increased hospital admission ( OR: 9.64; 95% CI, 1.25–74.35; P =.030 and OR: 4.09; 95% CI, 1.77–9.48, respectively) and mortality (OR: 1.64; 95% CI, 1.17–2.29, P =.030 and OR: 1.87; 95% CI, 1.18–2.97, respectively). 

Patients with diabetes mellitus (DM) had a decreased odds ratio for mortality (OR: 0.49; 95% CI, 0.33–0.73), but researchers were unable to establish a reason for this association.

Researchers attribute the rise in EE incidence rates to increasing intravenous drug use, the increasing age of the US population, and the existence of more immunocompromised patients resulting from immunotherapy, chemotherapy, and organ transplant procedures. They state “identification of patient demographics, prognostic factors and visit characteristics may serve to improve current management paradigms.”

Study limitations include the potential for missing data, documentation errors, and unverified clinical findings, and the lack of a specific diagnostic code for EE. 


Thangamathesvaran L, Canner JK, Scott AW, Woreta FA, Breazzano MP. National emergency department trends for endogenous endophthalmitis: an increasing public health challengeEye (Lond). Published online April 29, 2022. doi:10.1038/s41433-022-02080-9