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Ophthalmic manifestations of infections caused by the USA300 clone of community-associated methicillin-resistant Staphylococcus aureus.
- Source :
-
Ophthalmology [Ophthalmology] 2006 Aug; Vol. 113 (8), pp. 1455-62. Date of Electronic Publication: 2006 Jun 12. - Publication Year :
- 2006
-
Abstract
- Purpose: To report the microbiological, clinical, and pathological characteristics of community-associated methicillin-resistant Staphylococcus aureus (CAMRSA) infections of the eye and orbit.<br />Design: Prospective case series.<br />Participants: Nine patients with CAMRSA infections of the eye and orbit were identified during a 6-month period at 2 tertiary care hospitals in San Francisco.<br />Methods: Case identification was by prospective case selection and retrospective laboratory review of 549 MRSA cultures collected in the 2 hospitals. Ophthalmic microbial isolates were analyzed by pulsed-field gel electrophoresis and compared with a control CAMRSA clone (USA300). Clinical characteristics of patients infected with CAMRSA were reviewed, and all surgical specimens underwent pathological examination.<br />Main Outcome Measures: Pulsed-field gel electrophoresis banding patterns of MRSA isolates, antibiotic sensitivity profiles, patient demographics, systemic and ocular complications of infection, and posttreatment visual acuities.<br />Results: Nine ophthalmic isolates were CAMRSA clone USA300. The infections included orbital cellulitis, endogenous endophthalmitis, panophthalmitis, lid abscesses, and septic venous thrombosis. Patients were treated with trimethoprim-sulfamethoxazole, rifampin, clindamycin, or vancomycin based on microbial sensitivity studies and severity of infection. Eight of the 9 patients had no history of hospitalization. Seven patients required hospitalization, 3 required surgery, and an additional 4 required invasive procedures. Eight patients had good visual outcomes, but 1 deteriorated to no light perception. Pathological analyses showed extensive necrosis in eyelid and orbital specimens, and disorganized atrophy bulbi in an enucleated eye.<br />Conclusion: The USA300 CAMRSA clone, which carries Panton-Valentine leukocidin genes, can cause aggressive infections of the eye and orbit in hospital-naive patients. Treatment of infections often required debridement of necrotic tissues in addition to non-beta-lactam class antibiotics. In communities where CAMRSA is prevalent, ophthalmologists should obtain microbial cultures and sensitivity studies to help guide antibiotic therapy for severe ophthalmic infections.
- Subjects :
- Adult
Aged
Eye Diseases pathology
Eye Diseases physiopathology
Eye Diseases therapy
Female
Humans
Male
Middle Aged
Prospective Studies
Staphylococcus aureus genetics
Treatment Outcome
Community-Acquired Infections complications
Community-Acquired Infections microbiology
Eye Diseases microbiology
Methicillin Resistance
Staphylococcal Infections complications
Staphylococcal Infections microbiology
Staphylococcus aureus physiology
Subjects
Details
- Language :
- English
- ISSN :
- 1549-4713
- Volume :
- 113
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Ophthalmology
- Publication Type :
- Academic Journal
- Accession number :
- 16766029
- Full Text :
- https://doi.org/10.1016/j.ophtha.2006.03.031