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Methicillin-resistant Staphylococcus aureus dacryoadenitis

Wenjing Liu1, Daniel B Rootman1, Jesse L Berry2

  • 1Division of Orbital and Oculoplastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles.

JAMA Ophthalmology
|May 31, 2014
PubMed
Abstract

Insights

Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is increasingly causing acute dacryoadenitis. Prompt intravenous vancomycin followed by oral trimethoprim-sulfamethoxazole effectively treated these challenging MRSA eye infections.

Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Microbiology

Background:

  • Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are rising, challenging traditional views of MRSA as solely a nosocomial pathogen.
  • Acute dacryoadenitis, an inflammation of the lacrimal gland, is typically associated with bacterial or viral etiologies.

Observation:

  • Three adult cases of community-acquired MRSA acute dacryoadenitis presented with significant pain and periocular erythema over one week.
  • Clinical signs included an S-shaped lid deformity and purulent discharge from lacrimal gland abscesses in two patients.
  • Ocular cultures confirmed MRSA in all three cases.

Findings:

  • Intravenous vancomycin for 2-4 days, followed by oral trimethoprim-sulfamethoxazole for one week, resulted in complete clinical resolution for all patients.
  • MRSA dacryoadenitis demonstrated potential for rapid progression to orbital cellulitis if not adequately treated.

Implications:

  • These findings highlight the evolving epidemiology of MRSA, necessitating consideration of CA-MRSA in acute dacryoadenitis presentations.
  • Standard treatment protocols may be insufficient; early intravenous antibiotic therapy with targeted oral agents is recommended.
  • Prompt diagnosis and appropriate antibiotic selection are crucial to prevent severe complications such as orbital cellulitis.

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