Abstract：
Background: Gram-negative bacteria are causative agents of endogenous endophthalmitis (EBE). We aim to systematically review the current literature to assess the aetiologies, risk factors, and early ocular lesions in cases of Gram-negative EBE. Methods: All peer-reviewed articles between January 2002 and August 2022 regarding Gram-negative EBE were included. We conducted a literature search on PubMed and Cochrane Controlled Trials. Results: A total of 115 studies and 591 patients were included, prevalently Asian (98; 81.7%) and male (302; 62.9%). The most common comorbidity was diabetes (231; 55%). The main aetiologies were Klebsiella pneumoniae (510; 66.1%), Pseudomonas aeruginosa (111; 14.4%), and Escherichia coli (60; 7.8%). Liver abscesses (266; 54.5%) were the predominant source of infection. The most frequent ocular lesions were vitreal opacity (134; 49.6%) and hypopyon (95; 35.2%). Ceftriaxone (76; 30.9%), fluoroquinolones (14; 14.4%), and ceftazidime (213; 78.0%) were the most widely used as systemic, topical, and intravitreal anti-Gram-negative agents, respectively. The most reported surgical approaches were vitrectomy (130; 24.1%) and evisceration/exenteration (60; 11.1%). Frequently, visual acuity at discharge was no light perception (301; 55.2%). Conclusions: Gram-negative EBEs are associated with poor outcomes. Our systematic review is mainly based on case reports and case series with significant heterogeneity. The main strength is the large sample spanning over 20 years. Our findings underscore the importance of considering ocular involvement in Gram-negative infections.
摘要：
背景：革兰氏阴性菌是内源性眼内炎（EBE）的病原体。我们的目标是系统地回顾目前的文献，以评估病因，危险因素，革兰氏阴性EBE病例的早期眼部病变。方法：纳入了2002年1月至2022年8月之间有关革兰氏阴性EBE的所有同行评审文章。我们对PubMed和Cochrane对照试验进行了文献检索。结果：共纳入115项研究和591例患者，主要为亚洲人（98；81.7%）和男性（302；62.9%）。最常见的合并症是糖尿病(231;55%)。主要病因为肺炎克雷伯菌(510;66.1%),铜绿假单胞菌(111;14.4%),和大肠杆菌(60;7.8%)。肝脓肿（266；54.5％）是主要的感染源。最常见的眼部病变是玻璃体混浊（134；49.6％）和卵泡不足（95；35.2％）。头孢曲松(76;30.9%),氟喹诺酮(14；14.4%)，头孢他啶(213；78.0%)作为全身使用最广泛，topic,和玻璃体内抗革兰氏阴性药物，分别。报道最多的手术方法是玻璃体切除术（130；24.1％）和内脏/切除术（60；11.1％）。经常,出院时的视力为无光知觉(301；55.2%)。结论：革兰氏阴性EBE与不良预后相关。我们的系统评价主要基于具有显著异质性的病例报告和病例系列。主要优势是跨越20年的大样本。我们的发现强调了在革兰氏阴性感染中考虑眼部受累的重要性。
