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Risk factors and microbiological characteristics: from bacterial keratitis with hypopyon to keratitis-related endophthalmitis



To compare the clinical and microbiological characteristics in patients with bacterial keratitis with hypopyon (BKH), bacterial keratitis-related endophthalmitis (BKE), and bacterial endophthalmitis without keratitis (BE).


Data from all inpatients who were clinically diagnosed with BKH, BKE, and BE from 2018 to 2020 were collected retrospectively. The demographics, predisposing risk factors, clinical characteristics, microbiological profiles, and antibiotic susceptibility of the patients were evaluated.


Approximately 9.46% (28/296) of eyes with BKH progressed to endophthalmitis. The hypopyon (OR = 5.35, 95% CI: 2.17–7.08) and corneal perforation (OR = 2.47, 95% CI: 1.04–4.86) were significantly related to the development of BKE. The odds ratios for hypopyon of less than 1 mm, 1–3 mm, and greater than 3 mm were 1, 2.09 (95% CI: 1.17–3.15), and 4.12 (95% CI:2.59–5.68), respectively. The predominant causative pathogen was Staphylococcus epidermidis (36.43%, 38.89%), followed by Streptococci (14.73%, 16.67%), Staphylococcus aureus (8.53%, 7.79%), and Pseudomonas aeruginosa (9.30%, 7.14%) in eyes with BKH and BE. However, the main pathogens were Pseudomonas aeruginosa (37.50%) and Staphylococcus aureus (31.25%) in eyes with BKE. In the BKH, BKE, and BE groups, almost 100% of Staphylococcus aureus isolates were sensitive to vancomycin (97.70%, 100%, 95.56%), about a half were sensitive to fluoroquinolones (51.85%, 39.90%, 62.34%), and approximately 30% were sensitive to trimethoprim/sulfa (27.77%, 21.56%, 33.56%) and cefazolin (41.47%, 20.31%, 38.81%). The susceptibility of Pseudomonas aeruginosa to fluoroquinolones antibiotics was 55.75%, 66.67%, and 62.58%, respectively, in the three groups.


The height of hypopyon and corneal perforation are risk factors for progression to endophthalmitis in eyes with bacterial keratitis. When Staphylococcus aureus and Pseudomonas aeruginosa are identified, vigilance is required for advanced endophthalmitis.

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Fig. 1

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.


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We sincerely thank Ping Lin, Shandong Eye Institute, for her linguistic assistance.


This study was supported by National Natural Science Foundation of China (82070923, 81870639), Taishan Scholar Program (201812150, 20150215), the Academic Promotion Program and Innovation Project of Shandong First Medical University (2019RC009). The funding organization had no role in the design or conduct of this research.

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All the authors made a significant contribution to the work reported, including the conception, study design, execution, acquisition of data, analysis, and interpretation. All the authors took part in drafting, revising, and critically reviewing the article and approved the final manuscript. In addition, the authors have agreed on the journal to which this manuscript has been submitted and agree to be accountable for all aspects of the work.

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Correspondence to Hua Gao.

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This study was approved by the Institutional Review Board of Eye Hospital of Shandong First Medical University, China. No personally identifiable information was collected in this study. The requirement for informed consent from patients was also waived.

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The authors declare no competing interests.

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Zeng, F., Sun, Y., Ning, N. et al. Risk factors and microbiological characteristics: from bacterial keratitis with hypopyon to keratitis-related endophthalmitis. Graefes Arch Clin Exp Ophthalmol 260, 3019–3025 (2022).

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  • Keratitis-related endophthalmitis
  • Microbiological characteristics
  • Retrospective study
  • Risk factors