Methicillin-Resistant Staphylococcus Aureus Endophthalmitis: Wake-up Call for the Ophthalmologist
Purpose
Although still relatively rare, the incidence of Methicillin Resistant Staph Aureus (MRSA) eye infections is increasing and can be a horrifying experience for both the patient and surgeon when it occurs. This is a report of a patient who developed a fulminating endophthalmitis from a community acquired MRSA one week after cataract surgery, making me review my protocol and the literature to reduce the risk of future occurrences.
Methods
1) Identification of patients with risk factors: i.e. immuno-compromised from long-standing diabetes, chemotherapy, liver disease, HIV, and residents of long term facilities. 2) Use of a pre-op bacteriostatic or bactericidal agent that is effective against MRSA, i.e. trimethoprim since MRSA is becoming resistant to fourth generation fluroquinolones. 3) Suture clear corneal incisions in high risk patients.
Results
MRSA isolates are extremely virulent. Even though the current incidence of MRSA endophthalmitis is relatively low, adherence to the above protocol should lower it in high risk patients.
Conclusion
MRSA endophthalmitis is extremely destructive and can no longer be considered a rarity Fourth generation fluroquinolones are losing their effect on MRSA. Trimethoprim is an effective defense against MRSA.