Abstract
Abstract: :
Purpose:To describe the occurrence of community–onset methicillin–resistant Staphylococcus aureus (MRSA) infections of the lacrimal system and their treatment. While many cases of dacryocystitis caused by Staphylococcus aureus species have been reported in the American literature, few address methicillin resistance to date. Methods:Clinical and microbiological records of seven cases of acute or chronic MRSA dacryocystits occurring in non–hospitalized individuals were retrospectively reviewed. Results:Bacterial cultures revealed growth of MRSA in all patients. Antimicrobial sensitivities of MRSA isolates revealed resistance to oxacillin and sensitivity to vancomycin in all cases. Five of seven isolates were sensitive to gentamycin. Three patients were successfully treated with antibiotics and lacrimal surgery with no recurrence of symptoms after surgery for six months or greater. Four patients had temporary relief of symptoms with antibiotic therapy, but surgery was not performed due to non–ophthalmologic reasons. Conclusions:The treatment of MRSA dacryocystitis is challenging. Microbiologic cultures should be performed in all patients with dacryocysitis that is unresponsive to conventional first–line antibiotic treatment. Cultures should also be performed in patients with chronic conjunctivitis as undetected MRSA dacryocystitis may be contributing to their symptoms. It is our experience that bacterial isolates in patients with MRSA dacryocystitis are generally sensitive to vancomycin and gentamycin but resistant to fluoroquinolones, including the fourth–generation subclass. Appropriate antibiotic therapy in combination with dacryocystorhinostomy appears to be the optimal treatment.
Keywords: bacterial disease • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • antibiotics/antifungals/antiparasitics