A case of vancomycin-resistant enterococcus conjunctivitis and its clinically successful topical treatment.
OBJECTIVE
To describe what is, to our knowledge, the first documented case of vancomycin-resistant enterococcus (VRE) conjunctivitis and its successful topical treatment.


METHODS
A 77-year-old white man with end-stage multiple myeloma was hospitalized for congestive heart failure and pneumonia. During hospitalization, the patient developed conjunctivitis. Cultures of the eye were directly plated into several media. The bacterium was tested for antibiotic minimum inhibitory concentration (MIC) with the Clinical and Laboratory Standards Institute (CLSI) method.


RESULTS
Culture of the affected eye grew Enterococcus faecalis resistant to vancomycin. Topical treatment with moxifloxacin 0.5% (Vigamox; Alcon, Ft. Worth, TX) resulted in clinical resolution despite a MIC showing resistance.


CONCLUSIONS
Clinical resolution of VRE conjunctivitis was shown with topical moxifloxacin therapy in this case. At the same time, we suggest the use of combined topical and systemic therapy for treatment of VRE in immunocompromised patients.
Maguen
Ezra
E
Division of Ophthalmology, Cedars Sinai Medical Center, Los Angeles, CA, USA. maguene@cshs.org
Morgan
Margie A
MA
D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001372:Aza Compounds / Q000008:administration & dosage* / Q000627:therapeutic use; D003234:Conjunctivitis, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D013293:Enterococcus faecalis / Q000187:drug effects / Q000302:isolation & purification*; D024841:Fluoroquinolones; D005500:Follow-Up Studies; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D008297:Male; D000077266:Moxifloxacin; D009883:Ophthalmic Solutions; D011804:Quinolines / Q000008:administration & dosage* / Q000627:therapeutic use; D020713:Vancomycin Resistance
D000995:Antitubercular Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D009883:Ophthalmic Solutions; D011804:Quinolines; D000077266:Moxifloxacin