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Endogenous Methicillin-Resistant Staphylococcus Aureus (MRSA) Endophthalmitis: A Six-year Series at a Tertiary Care
Xinxin Zhang1, Frank L Brodie1, Eric A Postel1
1Duke University Eye Center, Duke University, Durham, North Carolina, USA.
Purpose:
To investigate the clinical outcomes of methicillin-resistant Staphylococcus aureus (MRSA) endophthalmitis.
Methods:
Clinical courses were reviewed for 17 eyes (15 patients) with endogenous MRSA endophthalmitis based on positive blood and vitreous culture or clinical suspicion between 2013 to 2019 at Duke University Hospitals.
Results:
Of 17 eyes, initial VA ranged from 20/40 to light perception. Of 15 patients, 9 had predisposing risk factors for bacteremia. All eyes received intravitreal vancomycin, 13 also received ceftazidime, and 2 also received amikacin instead of ceftazidime. Nine eyes developed retinal detachment; 6 underwent vitrectomy. Final VA ranged from 20/20 to no light perception and was ≥20/200 in 8 eyes. Eleven eyes had improved VA, 2 eyes were unchanged, and 4 were worse.
Conclusions:
This study is the largest series on endogenous MRSA endophthalmitis to date. Patients had a higher proportion of final VA ≥20/200, similarly high rate of RD, and fewer enucleations compared to prior reports.
Insights
This study shows that most patients with methicillin-resistant Staphylococcus aureus (MRSA) endophthalmitis achieved better vision with treatment. Fewer patients required eye removal compared to previous studies.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Endogenous endophthalmitis is a serious intraocular infection.
- Methicillin-resistant Staphylococcus aureus (MRSA) is a significant pathogen causing severe infections.
Purpose of the Study:
- To evaluate the clinical outcomes of endogenous MRSA endophthalmitis.
- To analyze treatment strategies and visual acuity results in MRSA endophthalmitis patients.
Main Methods:
- Retrospective review of 17 eyes from 15 patients with endogenous MRSA endophthalmitis (2013-2019).
- Analysis of initial and final visual acuity (VA), predisposing factors, treatment regimens (intravitreal vancomycin, ceftazidime, amikacin), and surgical interventions.
- Assessment of complications such as retinal detachment (RD) and outcomes including enucleation rates.
Main Results:
- Initial VA varied widely; 9 patients had bacteremia risk factors.
- All eyes received intravitreal vancomycin; combination therapy varied.
- Final VA was ≥20/200 in 8 eyes, with 11 eyes showing improved vision. RD occurred in 9 eyes, and 6 underwent vitrectomy.
Conclusions:
- This is the largest reported series of endogenous MRSA endophthalmitis.
- Patients demonstrated a favorable proportion of final VA ≥20/200.
- The study noted a high rate of RD but fewer enucleations compared to prior literature.
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