Bilateral methicillin-resistant Staphylococcus aureus keratitis after photorefractive keratectomy

J Cataract Refract Surg. 2007 Feb;33(2):316-9. doi: 10.1016/j.jcrs.2006.08.060.

Abstract

A 52-year-old woman with a history of liver transplantation developed bilateral corneal infiltrates 1 week after uneventful photorefractive keratectomy (PRK). Cultures grew methicillin-resistant Staphylococcus aureus (MRSA), resistant to fluoroquinolone antibiotics. The infections responded to topical vancomycin and resolved bilaterally over 3 weeks. Three months postoperatively, the uncorrected visual acuity (UCVA) was 20/20 in the right eye and 20/25 in the left eye; the best spectacle-corrected visual acuity (BSCVA) was 20/20 in both eyes. During the course of treatment, the patient reported chronic intermittent prophylactic use of oral ciprofloxacin. While fluoroquinolones typically provide excellent postoperative coverage, Staphylococcus organisms have a growing antibiotic resistance to fluoroquinolones, and MRSA may become a more prevalent organism in corneal infections. Chronic subtherapeutic fluoroquinolone use can increase the mutational resistance of Staphylococcus to fluoroquinolone and methicillin. The patient's frequent hospital visits placed her at high risk for MRSA colonization. This case represents the fifth reported case of MRSA keratitis after PRK.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Ciprofloxacin / therapeutic use
  • Eye Infections, Bacterial / diagnosis
  • Eye Infections, Bacterial / drug therapy
  • Eye Infections, Bacterial / etiology*
  • Female
  • Humans
  • Keratitis / diagnosis
  • Keratitis / drug therapy
  • Keratitis / etiology*
  • Lasers, Excimer
  • Methicillin Resistance*
  • Middle Aged
  • Photorefractive Keratectomy / adverse effects*
  • Staphylococcal Infections / diagnosis
  • Staphylococcal Infections / drug therapy
  • Staphylococcal Infections / etiology*
  • Staphylococcus aureus / drug effects
  • Staphylococcus aureus / isolation & purification*
  • Vancomycin / therapeutic use

Substances

  • Ciprofloxacin
  • Vancomycin