Quinupristin/Dalfopristin in Staphylococcus Aureus Endophthalmitis

A Case Report

Sergio E Hernandez-Da Mota

Disclosures

J Med Case Reports. 2011;5 

In This Article

Abstract and Introduction

Abstract

Introduction: The intravitreal injection of antibiotics remains the mainstay of therapy for postoperative endophthalmitis. Bacterial resistance, however, is still a pitfall in achieving an adequate response to treatment. Quinupristin/dalfopristin might be a feasible therapeutic option in these cases.
Case presentation: A 55-year-old Hispanic man had endophthalmitis secondary to Staphylococcus aureus in his right eye and was treated with intravitreal 0.4 mg/0.1 ml quinupristin/dalfopristin injection. Inflammation and pain remission were observed at four days after injection. The final best-corrected visual acuity was 20/40.
Conclusion: Although vancomycin remains the first-line intravitreal antibiotic therapy against infectious endophthalmitis caused by Gram-positive bacteria, quinupristin/dalfopristin exhibits similar efficacy and is theoretically more active against vancomycin-resistant strains, with no apparent retinal toxicity.

Introduction

Postoperative endophthalmitis has been a major and dreaded complication in all types of eye surgery. Several measures have been used for its prevention, such as aseptic techniques and topical prophylactic antibiotics. Although these measures have resulted in very low endophthalmitis incidence,[1] they have not been able to eliminate it completely.

Once infection is identified, the mainstay of therapy has been the intravitreal injection of antibiotics.[2] The concomitant use of pars plana vitrectomy and steroids has also been recommended[3] in some cases.

The most common bacterial etiology of the disease involves Gram-positive bacteria, especially Staphylococci. Vancomycin, a glucopeptide antibiotic, has shown adequate activity against this type of bacteria.[4]

Nonetheless, as with all kinds of antibiotics, resistance that could preclude a favorable outcome in these patients may emerge.[5]

Quinupristin/dalfopristin (Q/D), a recently developed streptogramin antibiotic, has shown better activity against vancomycin-resistant strains of staphylococci.[6]

The purpose of this report is to describe a case in which intravitreal quinupristin/dalfopristin injection in endophthalmitis due to Staphylococcus sp. resulted in remission of the infection.

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