Intravitreal Daptomycin for Recalcitrant Postoperative Endophthalmitis

Area of Science:

• Ophthalmology
• Infectious Diseases
• Pharmacology

Background:

• Postoperative endophthalmitis requires prompt and effective treatment.
• Vancomycin is a common first-line antibiotic for suspected Gram-positive bacterial infections, including endophthalmitis.
• Culture-negative endophthalmitis presents diagnostic and therapeutic challenges.

Observation:

• A patient developed acute postoperative endophthalmitis after vitrectomy.
• Initial treatment with intravitreal vancomycin, ceftazidime, and dexamethasone was ineffective.
• Despite multiple interventions, including repeat vitrectomies and antibiotic injections, the infection persisted.

Findings:

• Gram stain revealed Gram-positive cocci, but all cultures remained negative.
• Intravitreal daptomycin, administered during a second vitrectomy, successfully controlled the intraocular infection.
• This represents the first reported case of successful treatment of culture-negative, vancomycin-resistant endophthalmitis with intravitreal daptomycin.

Implications:

• Vancomycin resistance should be suspected in culture-negative postoperative endophthalmitis.
• Intravitreal daptomycin is a viable and effective alternative treatment option.
• Increased awareness of vancomycin resistance in endophthalmitis is crucial for effective clinical management.