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Endophthalmitis Caused by Methicillin-Resistant Staphylococcus aureus (MRSA)

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Endophthalmitis

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Abstract

Staphylococcus aureus is an important human bacterial pathogen responsible for a wide variety of ocular diseases, including sight-threatening infections such as keratitis, corneal flap melt after laser-assisted in situ keratomileusis (LASIK), cellulitis, endophthalmitis, and panophthalmitis. Staphylococcus aureus isolates that are resistant to methicillin are known as methicillin-resistant Staphylococcus aureus (MRSA) and are usually also resistant to other β-lactam antimicrobial drugs. In current practice, methicillin sensitivity is usually performed with oxacillin or cefoxitin, as methicillin is no longer commercially available in the United States. Oxacillin is more likely to maintain its activity during storage better than methicillin, while cefoxitin can give more reproducible and accurate results than tests with oxacillin or methicillin. The organisms are still called “MRSA” and not “oxacillin-resistant Staphylococcus aureus” or “cefoxitin-resistant Staphylococcus aureus” because of this historic role.

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Acknowledgment

We acknowledge support from NIH Center Core Grant P30EY014801 (Bethesda, Maryland), Research to Prevent Blindness Unrestricted Grant (New York, New York), and the Department of Defense (DOD Grant #W81XWH-09-1-0675) (Washington, DC).

We are thankful to Savitri Sharma MD, FAMS (Jhaveri Microbiology Center, L.V. Prasad Eye Institute, India) for providing us microbiology data included in this book chapter.

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Authors and Affiliations

  1. Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 N.W. 17th Street, Miami, FL, 33136, USA

    Nidhi Relhan, Stephen G. Schwartz, Avinash Pathengay, Darlene Miller & Harry W. Flynn Jr.

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  1. Nidhi Relhan
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Correspondence to Nidhi Relhan .

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  1. LV Prasad Eye Institute, Hyderabad, India

    Taraprasad Das

Frequently Asked Questions

Frequently Asked Questions

  1. 1.

    How different is methicillin-resistant Staphylococcus aureus infection from methicillin-sensitive Staphylococcus aureus infection?

    A: The patients may present with significant hypopyon, pain, and fibrinous exudates in anterior chamber. The visual acuity at presentation is also poor. There are no comparative clinical trials of MRSA vs. other organism infection.

  2. 2.

    What precautions are required to reduce the incidence of MRSA proliferation?

    A: Suggested read—refer to section “Prevention Strategy.”

  3. 3.

    What is the suggested management for case of endophthalmitis with suspected MRSA?

    A: Proceed with initial tap and inject with vancomycin and ceftazidime. If not responding, then consider early pars plana vitrectomy in these cases. The use of other drugs such as linezolid, quinupristin/dalfopristin, or daptomycin is based on cost/availability/affordability.

  4. 4.

    What is the suggested management for case of endophthalmitis with confirmed MRSA?

    A: Proceed with initial tap and inject with vancomycin and ceftazidime. If clinical response is favorable, continue topical antibiotics, and consider repeat intravitreal vancomycin.

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Relhan, N., Schwartz, S.G., Pathengay, A., Miller, D., Flynn, H.W. (2018). Endophthalmitis Caused by Methicillin-Resistant Staphylococcus aureus (MRSA). In: Das, T. (eds) Endophthalmitis . Springer, Singapore. https://doi.org/10.1007/978-981-10-5260-6_18

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