Quinupristin/dalfopristin in Staphylococcus aureus endophthalmitis: a case report

<p>Abstract</p> <p>Introduction</p> <p>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.</p> <p>Case presentation</p> <p>A 55-year-old Hispanic man had endophthalmitis secondary to <it>Staphylococcus aureus </it>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.</p> <p>Conclusion</p> <p>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.</p

Spectral domain optical coherence tomography in patients after successful management of postoperative endophthalmitis following cataract surgery by pars plana vitrectomy.

BACKGROUND: Acute severe postoperative endophthalmitis may lead to severe vision loss. The aim of this study was the analysis of macular microstructure imaged by spectral domain optical coherence tomography in patients after pars plana vitrectomy due to postcataract endophthalmitis. METHODS: A cross sectional study was carried out in 17 patients who had cataract surgery in both eyes and underwent unilateral pars plana vitrectomy due to postcataract endophthalmitis. Postoperative best corrected visual acuity was determined in both eyes. Evaluation of macular thickness, macular volume, peripapillary retinal nerve fiber layer thickness and choroidal thickness using enhanced depth imaging technique was performed by spectral domain optical coherence tomography. The measurements obtained in the operated eye were compared to the fellow eye by Wilcoxon matched pair test. Correlation test was performed by Spearman rank order. RESULTS: A mean postoperative best corrected visual acuity of 63 +/- 30 ETDRS letters versus 75 +/- 21 letters was achieved in the study and fellow eyes, respectively, after a mean of 5.3 +/- 4.5 months (p = 0.1). The mean macular thickness was 320.6 +/- 28.8 mum SD in the study eyes compared to 318.4 +/- 18.8 mum in the fellow eyes (p = 0.767). No differences were noted in macular volume (p = 0.97) and in peripapillary retinal nerve fiber layer thickness (p = 0.31). Choroidal thickness was significantly lower in the study eyes compared to the fellow eyes (p = 0.018). Epiretinal membrane was found in 7 eyes after endophthalmitis, while in the fellow eyes only in 3 cases (p = 0.13, Fisher's exact test). CONCLUSION: Choroidal thickness decreased significantly after endophthalmitis, but there was no functional correlation with the changes in choroidal microstructure. The development of epiretinal membranes may be associated with either vitrectomy or endophthalmitis in the history. Absence of other significant structural and morphological findings shows that successful treatment may guarantee good clinical results even in long term after this severe postoperative complication