The Distant Metastasis of Pyogenic Liver Abscess Caused by Klebsiella pneumoniae Serotype K2 and the Underlying Disease of Diabetes Mellitus Should Be Carefully Interpreted

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Abstract
Tthe Editor—A recent article by Fang et al. [1] mentioned that diabetes mellitus (DM) is not a significant risk factor for septic ocular or CNS complications in Klebsiella pneumoniae liver abscess (KP-LA). In the study by Fang and colleagues, 13 (57%) of 23 patients with distant metastasis to eye or CNS were affected with DM. Previous studies showed that 67%–95.5% of the KP-LA-affected patients with distant metastasis were affected with DM [2–5]. In 2 studies, with overall enrollment of 354 patients with KP-LA, DM was verified as a significant factor for developing severe extrahepatic complications [4, 5] and poor visual outcome of endophthalmitis [5]. We suggest that subjects with DM should not be ignored in the future study of KP-LA and that the definition of severe metastatic complications of KP-LA should not be confined to eye and CNS only.