ABSTRACT
PURPOSE: Staphylococcus aureus (SA) endophthalmitis is generally a postsurgical infection with an undefined source of entry. Hospital-acquired (HA) SA infections are associated with multi-antibiotic resistance and absence of the Panton-Valentine Leukocidin (PVL) toxin. Community-acquired (CA) SA infections are not associated with multi-antibiotic resistance and possess the PVL toxin. We hypothesize that CA infection is more common than HA for SA endophthalmitis. METHODS: Twenty de-identified SA isolates, collected from the vitreous and/or aqueous of clinical endophthalmitis, were tested for the presence of PVL toxin and antibiotic susceptibility. PVL testing was performed using a kit to detect the Staphylococcal toxin by reversed passive latex agglutination (PVL-RPLA "Seiken," Denka Seiken Co., LTD). SA isolates were tested for antibiotic susceptibility using disk diffusion at the time of isolation. Multi-antibiotic resistance was defined as resistance to at least 3 classes of antibiotics. RESULTS: Of the 20 isolates, 15 were multi-antibiotic resistant and PVL-negative consistent with HA, and 1 was not multi-antibiotic resistant and PVL-positive, consistent with CA. Two isolates tested positive for PVL with one demonstrating both methicillin and fluoroquinolone (FQ) resistance. Of the 18 PVL-negative SA isolates, 15 (83%) were multi-antibiotic resistant (12 methicillin-resistant SA, 14 FQ resistant). CONCLUSIONS: Our results reject the hypothesis that SA isolated from endophthalmitis is consistent with CA sources due to the lack of the PVL toxin and multiple resistant patterns of the SA. PVL does not appear to be a key virulence factor for the development of SA endophthalmitis.
Subject(s)
Cross Infection/microbiology , Endophthalmitis/microbiology , Staphylococcal Infections/microbiology , Staphylococcus aureus/isolation & purification , Anti-Bacterial Agents/pharmacology , Bacterial Toxins/isolation & purification , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , Community-Acquired Infections/microbiology , Cross Infection/drug therapy , Cross Infection/epidemiology , Drug Resistance, Multiple, Bacterial , Endophthalmitis/drug therapy , Endophthalmitis/epidemiology , Exotoxins/isolation & purification , Humans , Leukocidins/isolation & purification , Microbial Sensitivity Tests , Staphylococcal Infections/drug therapy , Staphylococcal Infections/epidemiology , Staphylococcus aureus/drug effectsABSTRACT
PURPOSE: To report on a novel treatment strategy in an eye with a retinal angioma and macular edema METHODS: Wide-angle angiography was used to characterize the lesion and response to theraphy, while the treatment combined laser photocoagulation with the indirect laser delivery system, and intravitreal injections of pegaptanib and bevacizumab. Treatment was rendered over 21 months' time. RESULTS: The treatment resulted in graduate resolution of marked macular edema and exudation, with a gain in visual acuity. CONCLUSION: A combination of laser photocoagulation and anti-VEGF theraphy can be effective in the treatment of macular exudation and edema from a retinal angioma.
