Viêm nội nhãn tự phát do Klebsiella pneumoniae siêu độc lực - Một bệnh nổi lên toàn cầu
Tóm tắt
Bài tổng quan này nhằm ghi nhận tình trạng viêm nội nhãn tự phát do Klebsiella pneumoniae (Kp) siêu độc lực (hvKp) mới nổi, xem xét về tỷ lệ, đặc điểm vi sinh vật của tác nhân gây bệnh, các yếu tố nguy cơ liên quan, cách quản lý và kết quả điều trị. Các chủng hvKp gây ra áp xe gan xâm lấn (LA) với các triệu chứng lâm sàng đặc trưng. Từ 80–90% số trường hợp có áp xe gan làm tiêu điểm chính của nhiễm trùng, tiếp theo là nhiễm trùng hvKp ở thận hoặc phổi. Tuy nhiên, tỷ lệ viêm nội nhãn tự phát ở bệnh nhân mắc KPLA dao động từ 3.4% (19) đến 12.6% (13), với tổng số 95 trường hợp viêm nội nhãn trong 1455 trường hợp KPLA (6.5%). Mất thị lực nghiêm trọng được ghi nhận trong 75% số trường hợp, với 25% có tổn thương hai bên. Kháng sinh nội nhãn là phương pháp điều trị chính. Phẫu thuật lấy dịch kính qua đường kính phía sau là một vấn đề gây tranh cãi. Các chủng hvKp hầu hết biểu hiện kiểu kháng thuốc tự nhiên “hoang dã” gợi ý cho các nhiễm trùng mắc phải trong cộng đồng, rất nhạy cảm với thế hệ cephalosporin thứ ba và thứ tư cũng như carbapenem. Kháng kháng sinh ở các chủng siêu độc lực mới đây đã được ghi nhận thông qua quá trình chuyển gen plasmid và có thể dẫn đến các trường hợp rất khó điều trị. Sự lan truyền toàn cầu của các chủng này là một thay đổi dịch tễ học lớn cần được xem xét trong quản lý chẩn đoán và điều trị bệnh nhân viêm nội nhãn tự phát. Sàng lọc nhãn khoa ở những bệnh nhân mắc KPLA và các nhiễm trùng hvKp khác cùng với một phương pháp điều trị đa ngành là vô cùng quan trọng cho chẩn đoán sớm và bảo tồn chức năng thị lực.
Từ khóa
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