title: Bilateral methicillin-resistant staphylococcus aureus keratitis in a medical resident following an uneventful bilateral photorefractive keratectomy.
abstract: OBJECTIVE
  To present a case of bilateral methicillin-resistant Staphylococcus aureus (MRSA) keratitis after photorefractive keratectomy (PRK).
  
  
  METHODS
  Retrospective chart review. RESULTS A 26-year-old female internal medicine resident underwent an uneventful bilateral PRK. After the procedure, the patient was fit with a bandage contact lens and was prescribed tobramycin 0.3%, fluorometholone 0.1%, and diclofenac sodium 0.1% four times per day. Postoperatively, corneal ulcers were noted in each eye, and the patient was referred for a consultation. Gram stain showed gram-positive cocci. The patient immediately started using vancomycin, 35 mg/mL every half hour, and ofloxacin 0.3% every hour around the clock. Forty-eight hours later, corneal and lid cultures were positive for MRSA. Three months after the infection, there was approximately 40% corneal thinning in the right eye and 10% thinning in the area of the corneal ulceration of the left eye. The patient is awaiting corneal transplantation of the right eye.
  
  
  CONCLUSIONS
  To our knowledge, this represents the first reported case of bilateral MRSA keratitis after PRK. Methicillin-resistant S. aureus is a potentially serious infectious agent after PRK and may be associated with exposure to a hospital setting. For patients who have had extensive exposure to a hospital environment and are undergoing ocular surgery, we recommend prophylaxis against MRSA. To treat a possible MRSA keratitis, we suggest starting a fourth-generation topical fluoroquinolone every 30 minutes, alternating it with vancomycin 50 mg/mL every 30 minutes, and discontinuing steroid use. A high degree of suspicion coupled with rapid and appropriate treatment may result in improved visual recovery.
authors.affiliation: Ophthalmic Consultants of Long Island, Rockville Centre, NY, USA.
authors.forename: Renée
authors.initials: R
authors.lastname: Solomon
authors.forename: Eric D
authors.initials: ED
authors.lastname: Donnenfeld
authors.forename: Henry D
authors.initials: HD
authors.lastname: Perry
authors.forename: Seth
authors.initials: S
authors.lastname: Biser
mesh_terms: D000328:Adult; D003315:Cornea / Q000382:microbiology; D003320:Corneal Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005143:Eyelids / Q000382:microbiology; D005260:Female; D006801:Humans; D007396:Internship and Residency; D054018:Lasers, Excimer; D016106:Methicillin Resistance; D015242:Ofloxacin / Q000627:therapeutic use; D018903:Photorefractive Keratectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D014640:Vancomycin; D015242:Ofloxacin