Quinupristin/dalfopristin in vancomycin-resistant Staphylococcus aureus endophthalmitis.

Postoperative bacterial endophthalmitis is the most dreaded complication of any eye surgery. Once infection is suspected, prompt treatment by vitreous tap and biopsy or by vitrectomy and injection of intravitreal antibiotics is instituted prior to identifying the specific bacteria and its antibiotic sensitivities. Of the 70% of cases that were culture positive in the Endophthalmitis Vitrectomy Study (EVS), 94% were grampositive organisms that were all sensitive to vancomycin. The recent Antibiotic Resistance Monitoring in Ocular micRorganisms 2009 study reported that 39% of Staphylococcus aureus isolates were resistant to methicillin, but all were still sensitive to vancomycin. Several recent cases of endophthalmitis due to vancomycin-resistant S aureus and Enterococcus have also been reported. Of the few antibiotics effective against vancomycin-resistant bacteria, only intravitreal quinupristin/dalfopristin has been reported previously in a single human eye. In the current series, 2 additional cases are reported with successful treatment of vancomycin-resistant S aureus endophthalmitis with intravitreal quinupristin/dalfopristin.