Endogenous endophthalmitis due to clinically vancomycin-resistant Staphylococcus aureus.

Abstract

To report a case of clinically vancomycin-resistant Staphylococcus aureus endophthalmitis. This is an observational case report of a patient referred for decreased vision during an admission for methicillin-resistant S. aureus bacteremia. A 48-year-old woman with methicillin-resistant S. aureus bacteremia presented with decreased vision in one eye. Best-corrected visual acuity at presentation was 20/25 in the right eye and hand motion in the left eye. Biomicroscopic examination revealed evidence of endophthalmitis in both eyes. After a period of deterioration despite treatment with intravenous and intravitreal vancomycin and intravitreal ceftazidime-20/200 in the right eye and light perception in the left eye, an alternative treatment regimen with intravenous daptomycin and intravitreal clindamycin and amikacin led to clinical improvement in both eyes, with quiescence of anterior chamber cell and vitritis. Best-corrected visual acuity at 3 weeks of follow-up had improved to 20/40 in the right eye and remained light perception in the left eye. In cases of endogenous endophthalmitis secondary to methicillin-resistant S. aureus not responsive to intravenous and intravitreal vancomycin, particularly with borderline sensitivities, consideration to clinical resistance should be entertained.