Methicillin-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus epidermidis infections in the cornea

被引:81
作者
Sotozono, C [1 ]
Inagaki, K [1 ]
Fujita, A [1 ]
Koizumi, N [1 ]
Sano, Y [1 ]
Inatomi, T [1 ]
Kinoshita, S [1 ]
机构
[1] Kyoto Prefectural Univ Med, Dept Ophthalmol, Kamigyo Ku, Kyoto 6020841, Japan
关键词
keratitis; methicillin-resistant; Staphylococcus aureus; methicillin-resistant Staphylococcus epidermidis; vancomycin eye ointment;
D O I
10.1097/01.ico.0000263127.84015.3f
中图分类号
R77 [眼科学];
学科分类号
100212 ;
摘要
Purpose. To describe the incidence and clinical management of corneal infections with methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-resistant Staphylococcus epidermidis (MRSE). Methods. The incidence of methicillin-resistant Staphylococcus (MRS) at the Department of Ophthalmology, Kyoto Prefectural University of Medicine, was reviewed during the 5-year period from January 1996 to December 2000. Clinical aspects of MRS colonization or infection in the eye were investigated. Results. Methicillin-resistant S. aureus or MRSE was detected from 30 eyes with ocular diseases; post-keratoplasty (I I eyes), ocular surface disorders without operation (9 eyes), and others (10 eyes). Among the 30 eyes, 12 manifested keratitis. Eight cases (8 eyes) occurred after keratoplasty, including four postoperative cases in patients with Stevens-Johnson syndrome, and two bilateral cases (4 eyes) in patients with acute-phase Stevens-Johnson syndrome. The degree of MRS keratitis was classified into 4 groups: asymptomatic carrier or conjunctivitis, intraepithelial infiltrations, superficial keratitis, and severe keratitis leading to corneal perforation. All cases of keratitis were treated successfully with topical ofloxacin (OFLX), vancomycin (VCM), or arbekacin (ABK). Conclusion. Factors associated with ocular MRS colonization were long-term use of antibiotics and/or steroids, and hospitalization. Patients who had undergone keratoplasty or who had Stevens-Johnson syndrome were at increased risk of MRS keratitis. Superficial stromal infiltrations, minimal melting, and minimal stromal scarring are characteristic of MRS keratitis. Therapy for MRS keratitis is summarized. Ofloxacin, VCM, and ABK are effective in the treatment of MRS keratitis. Vancomycin eye ointment is effective as the final choice in serious cases.
引用
收藏
页码:S94 / S101
页数:8
相关论文
共 37 条
[1]   THE POTENTIAL USE OF QUINOLONES IN FUTURE OCULAR ANTIMICROBIAL THERAPY [J].
BORRMANN, LR ;
LEOPOLD, IH .
AMERICAN JOURNAL OF OPHTHALMOLOGY, 1988, 106 (02) :227-229
[2]  
BRENNEN C, 1990, AM J MED, V88, pN14
[3]   METHICILLIN-RESISTANT STAPHYLOCOCCUS-AUREUS [J].
BRUMFITT, W ;
HAMILTONMILLER, J .
NEW ENGLAND JOURNAL OF MEDICINE, 1989, 320 (18) :1188-1196
[4]  
Burd EM., 1994, The cornea. Scientific foundations and Clinical practice, VThird, P115
[5]   METHICILLIN-RESISTANT STAPHYLOCOCCUS-AUREUS KERATITIS IN THE RABBIT - THERAPY WITH CIPROFLOXACIN, VANCOMYCIN AND CEFAZOLIN [J].
CALLEGAN, MC ;
HILL, JM ;
INSLER, MS ;
HOBDEN, JA ;
OCALLAGHAN, RJ .
CURRENT EYE RESEARCH, 1992, 11 (11) :1111-1119
[6]  
CALLEGAN MC, 1994, INVEST OPHTH VIS SCI, V35, P1033
[7]  
Castillo A, 1997, CORNEA, V16, P420
[8]   RETROSPECTIVE STUDY OF THE TOXICITY OF PREPARATIONS OF VANCOMYCIN FROM 1974 TO 1981 [J].
FARBER, BF ;
MOELLERING, RC .
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 1983, 23 (01) :138-141
[9]   TOPICAL VANCOMYCIN FORMULATION FOR METHICILLIN-RESISTANT STAPHYLOCOCCUS-EPIDERMIDIS BLEPHAROCONJUNCTIVITIS [J].
FLEISCHER, AB ;
HOOVER, DL ;
KHAN, JA ;
PARISI, JT ;
BURNS, RP .
AMERICAN JOURNAL OF OPHTHALMOLOGY, 1986, 101 (03) :283-287
[10]   Methicillin-resistant Staphylococcus aureus keratitis after excimer laser photorefractive keratectomy [J].
Förster, W ;
Becker, K ;
Hungermann, D ;
Busse, H .
JOURNAL OF CATARACT AND REFRACTIVE SURGERY, 2002, 28 (04) :722-724