Community-Associated Methicillin-Resistant Staphylococcus Aureus Subretinal Abscess in a Nonbacteremic Patient Treated With Internal Drainage and Retinectomy

Abstract

Purpose: To report a case of community-associated methicillin-resistant Staphylococcus aureus subretinal abscess that continued to progress, despite intravitreal and systemic antibiotic therapy.Methods: Retrospective chart review of a 77-year-old female patient with well-controlled diabetes mellitus who developed a left eye endophthalmitis and subretinal abscess from methicillin-resistant S. aureus colonization in the absence of any systemic focus of infection.Results: The abscess and endophthalmitis resolved after the second pars plana vitrectomy that included drainage of a subretinal abscess after the failure of initial pars plana vitrectomy, and intravitreal and systemic antibiotics. Retinal detachment due to proliferative vitreoretinopathy necessitated the third pars plana vitrectomy 2 weeks after the second pars plana vitrectomy. Conclusion:The authors present an unusual case of methicillin-resistant S. aureus subretinal abscess in a patient with methicillin-resistant S. aureus colonization with negative blood, aqueous humor culture, and vitreous culture but a positive culture from subretinal aspirate.

Subretinal abscess: causative pathogens, clinical features and management

“…Steroids were used in four cases of bacterial etiology: one receiving intravitreal dexamethasone at the end of vitrectomy [ 19 ] and three receiving oral steroids, of whom one was also on systemic anti-tubercular treatment. Intravitreal dexamethasone was given in a diabetic patient with SRA caused by S. aureus where the final VA improved.…”

“…In the forms with vitritis where ocular sampling was done the vitreous was the commonest ocular site of pathogen identification. However, failure of vitreous sampling in isolating the pathogen has been described by many authors, who were subsequently able to isolate it by direct drainage of the lesion [ 11 , 19 ]. Despite vitritis being observed with a similar frequency in both groups (81.8% versus 83%) the vitreous yielding rate was higher in the forms without systemic infective foci (43.8% versus 35.7%).…”

Bilateral sequential choroidal abscess secondary to methicillin-resistant Staphylococcus aureus endogenous endophthalmitis

“…Only 1 case required vitrectomy and transretinal abscess drainage, with subsequent retinal detachment repair. 4 Choroidal abscesses secondary to infection from Streptococcus, Pseudomonas, Klebsiella, and Nocardia have also been reported. 2,4,9 The rarity of endogenous endophthalmitis and its nonspecific presentation may cause delays in diagnosis and treatment ranging from 16% to 63%, with uveitis being the most common misdiagnosis.…”

“…4 Choroidal abscesses secondary to infection from Streptococcus, Pseudomonas, Klebsiella, and Nocardia have also been reported. 2,4,9 The rarity of endogenous endophthalmitis and its nonspecific presentation may cause delays in diagnosis and treatment ranging from 16% to 63%, with uveitis being the most common misdiagnosis. 1,2 Prognosis is often poor with complications, including blindness, phthisis, evisceration or enucleation, retinal detachment, and death.…”