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J. Winokur, V. A. Deramo, J. C. Lai, J. Luchs, H. Ailani, I. J. Udell; Visual Outcome and Bacterial Sensitivity After MRSA-Associated Acute Endophthalmitis. Invest. Ophthalmol. Vis. Sci. 2007;48(13):693.
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To determine visual outcomes and bacterial sensitivity in cases of MRSA-associated acute endophthalmitis following cataract surgery.
A retrospective review was performed on 64 consecutive cases of acute endophthalmitis that presented to a vitreo-retinal practice within six weeks following cataract surgery from September 1, 2003 to August 31, 2006. Cases with a positive MRSA culture were studied. Visual outcomes and bacterial sensitivities were recorded.
Six eyes of six patients (9.4%) with MRSA-associated endophthalmitis were identified. All 6 eyes were started on fluoroquinolone antibiotics 3 days before surgery [gatifloxacin (n=4), moxifloxacin (n=1), and ofloxacin (n=1)]. Corneal abnormalities, ranging from wound infection to corneal opacification, were noted in 5 of the 6 cases (83.3%). Visual acuity at last follow-up was NLP in two eyes, LP in two eyes, and 20/30 or better in two eyes. One eye with NLP vision underwent enucleation within 3 days of presentation due to panopthalmitis and impending sepsis. All six organisms were sensitive to both gentamicin and vancomycin. Although not all organisms were tested against all fluoroquinolone antibiotics, no organism was sensitive to any fluoroquinone in vitro (ofloxacin, gatifloxacin, and moxifloxacin - 0/2 organisms sensitive; ciprofloxacin - 0/4 organisms sensitive; levofloxacin - 0/5 sensitive).
MRSA-associated endophthalmitis accounts for approximately 10% of post-cataract endophthalmitis cases at our institution and frequently leads to a poor visual outcome, including loss of all vision and potential loss of the eye. Fluoroquinolone antibiotic prophylaxis for three days before cataract surgery did not prevent clinical infection in these patients. Corneal abnormalities were seen in the majority of cases. MRSA endophthalmitis organisms were resistant in vitro to all fluoroquinolone antibiotics tested, though the isolates were uniformly sensitive to gentamicin and vancomycin in this study.
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