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Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
SUBTENON'S VANCOMYCIN INJECTION FOR SUBRETINAL ABSCESS SECONDARY TO METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS
Lucas W Rowe1, Luke G McVeigh, Amir R Hajrasouliha
1Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana.
Purpose:
To report the use of a subtenon's vancomycin injection for the treatment of subretinal abscess secondary to methicillin-resistant Staphylococcus aureus endogenous endophthalmitis.
Methods:
A 17-year-old man developed endogenous endophthalmitis with subretinal abscess in his right eye secondary to methicillin-resistant Staphylococcus aureus bacteremia from axillary necrotizing fasciitis. Despite prompt treatment with IV vancomycin and an intravitreal vancomycin injection, the patient displayed minimal improvement. The patient was subsequently treated with a subtenon's vancomycin injection. The injection technique is described in detail, as well as a review of the treatment options available for bacterial subretinal abscesses.
Results:
On presentation, examination revealed minimal vitritis and a large yellow subretinal abscess superotemporally extending close to the macula with subretinal fluid inferotemporally involving the macula. Four days postintravitreal vancomycin injection, the abscess remained stable and the patient developed an exudative detachment temporally. Vancomycin was injected superotemporally in the subtenon's space with no complications during the procedure or during his postoperative recovery. At seven days postinjection, the subretinal abscess and exudative retinal detachment resolved completely with necrosis at the area of previous abscess.
Conclusion:
We present the first successful case of subtenon's vancomycin injection for the treatment of bacterial subretinal abscess. Our case demonstrates that subtenon's injection of antibiotics is a safe and effective nonsurgical management option for bacterial subretinal abscesses.
Insights
Subtenon
Area of Science:
- Ophthalmology
- Infectious Diseases
- Pharmacology
Background:
- Endogenous endophthalmitis caused by methicillin-resistant Staphylococcus aureus (MRSA) can lead to severe vision loss.
- Subretinal abscesses are a sight-threatening complication of MRSA endophthalmitis.
- Standard treatments like intravenous and intravitreal vancomycin may not always be sufficient.
Purpose of the Study:
- To evaluate the efficacy and safety of subtenon's vancomycin injection for treating a subretinal abscess.
- To present a novel, minimally invasive treatment approach for a complex ocular infection.
Main Methods:
- A case report of a 17-year-old male with MRSA endophthalmitis and a subretinal abscess.
- Administration of a subtenon's vancomycin injection after suboptimal response to IV and intravitreal vancomycin.
- Detailed description of the subtenon's injection technique and a review of current treatment options.
Main Results:
- The subretinal abscess and associated exudative retinal detachment resolved completely within seven days post-subtenon's injection.
- No complications were observed during or after the subtenon's vancomycin injection procedure.
- Histopathological examination revealed necrosis at the site of the previous abscess.
Conclusions:
- Subtenon's vancomycin injection is a safe and effective nonsurgical option for bacterial subretinal abscesses.
- This approach offers a viable alternative when conventional treatments fail.
- Highlights the potential of localized antibiotic delivery in managing severe intraocular infections.
