Endogenous Endophthalmitis Caused by Carbapenem-Resistant Hypervirulent Klebsiella Pneumoniae: A Case Report and Literature Review

Purpose: To report a rare case of endogenous endophthalmitis caused by carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP). Methods: A retrospective chart review was conducted. The isolates were characterized by hypermucoviscosity, resistance genes, virulence genes, and multilocus sequence typing. Results: A 47-year-old diabetic woman acquired carbapenem-resistant K. pneumoniae (CRKP) nosocomial pneumonia. Metastatic endophthalmitis occurred in the right eye a week after the occurrence of CRKP bloodstream infection (BSI). Visual acuity decreased to light perception within 3 days. Although vitrectomy relieved ocular pain, endophthalmitis deteriorated due to uncontrollable BSI, and developed to corneal perforation. The strains isolated from bronchoalveolar lavage fluid, blood, and intraocular pus originated from the same clone. The pathogen was hypermucoviscous, belonged to sequence type 11, harbored resistance genes bla_KPC-2, bla_TEM, bla_SHV, rmtB, and virulence genes rmpA2, iucABCD, iroBCD. Conclusions: Endogenous endophthalmitis caused by CR-hvKP has emerged, which is a treatment challenge for both ophthalmologists and physicians.