Methicillin-resistant Staphylococcus aureus (MRSA) Orbital Cellulitis- A case report and literature review

Authors

  • Siti Amirah Hassan Ophthalmology
  • Rafidah MD Salleh
  • Norlaila Talib
  • Adil Hussein

Keywords:

orbital cellulitis, methicillin-resistance staphylococcus aureus, vancomycin

Abstract

Orbital cellulitis is a clinical diagnosis. Once the diagnosis is made, an empirical antibiotic is started, and in most cases, the clinical improvement can be observed within 24-48 hours. We discuss treatment options in managing orbital cellulitis in a 34-year-old male in which no improvement was seen despite being started on empirical broad-spectrum antibiotic. Patient had a prior history of being bitten by an insect in the left upper eyelid while doing gardening about 5 days prior to admission. The patient developed left orbital cellulitis a few days following the insect bite. Patient was started empirical broad-spectrum antibiotic immediately, but no improvement observed. Culture and sensitivity taken from the upper eyelid grew methicillin-resistance Staphylococcus aureus (MRSA) which was sensitive to vancomycin. Patient was treated with intensive fourteen days of intravenous vancomycin. The infection resolved as evidenced by clinical improvement and reduction of white blood cells count

References

Jevons M.P. ‘Celbenin’-resistant staphylococci. Br. Med. J. 1, 124–125.(1961) url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1952888/

Rio Ad. et al. Patients at Risk of Complications of Staphylococcus aureus Bloodstream Infection. Clinical Infectious Disease 48, S246-253 (2009). doi: https://doi.org/10.1086/598187

Herold BC. et al. Staphylococcus aureus in Children With No IdentifiedPredisposing Risk. JAMA 279, 593–598 (1998).

Taylor G & Kirkland T. A multistrain cluster of Staphylococcus aureus based in a native community. Can J Infect Dis 1, 121–126 (1990).

Udo E. E. Genetic analysis of community isolates of Staphylococcus aureus in Western Australia. J. Hosp. Infect. 25, 97–108 (1993).

Naimi T. S. et al. Epidemiology and Clonality of Community- AcquiredMethicillin-Resistant Staphylococcus aureus in Minnesota, 1996 – 1998. CID 33, 990–996 (2001).

Groom A. V et al. Community-Acquired Methicillin-Resistant Staphylococcus aureus in a American Indian Community. JAMA 286, 1201–1205 (2001).

Skov R. et al. International Journal of Antimicrobial Agents Update on the prevention and control of community-acquired meticillin-resistant Staphylococcus aureus (CA-MRSA). Int. J. Antimicrob. Agents 39, 193–200 (2012).

Asbell P. A., Sahm D. F., Shaw M., Draghi D. C. & Brown N. P. Increasing prevalence of methicillin resistance in serious ocular infections caused by Staphylococcus aureus in the United States: 2000 to 2005. J Cataract Refract Surg 34, 814–818 (2008).

SH M., Yen M. T., Miller A. M. & Yen K. G. Microbiology of Pediatric Orbital Cellulitis. Am J Ophthalmo 144, 497–501 (2007).

Liao S., Durand M. L. & Cunningham M. J. Sinogenic orbital and subperiosteal abscesses: Microbiology and methicillin-resistant Staphylococcus aureus incidence. YMHN 143, 392–396 (2010).

Reddy S. C., Sharma H. S., Mazidah A. S., Darnal H. K. & Mahayidin M. Orbital abscess due to acute ethmoiditis in a neonate. Int. J. Pediatr. Otorhinolaryngol. 49, 81–86 (1999).

Rutar T., Zwick O. M., Cockerham K. P. & Horton, J. C. Bilateral Blindness From Orbital Cellulitis Caused by Community- Acquired Methicillin-Resistant. Am. Acad. Ophthalmol. 140, 740–742 (2005).

Sam I. et al. Multisensitive community-acquired methicillin-resistant Staphylococcus aureus infections in Malaysia. Diagn. Microbiol. Infect. Dis. 62, 437–439 (2008).

Nari S. H. A., Aragama Y. A. G. K. & Ulton B. A. F. Neonatal disseminated methicillin-resistant Staphylococcus aureus presenting as orbital cellulitis. J. Laryngol. 119, 64–67 (2005).

Chaudhry I. A., Shamsi F. A. & Elzaridi E. Outcome of Treated Orbital Cellulitis in a Tertiary Eye Care Center in the Middle East. Am. Acad. Ophthalmol. 114, 345–354 (2007).

James R. Chandler, David J. Langenbrunner, E. R. S. The pathogenesis of orbital complications in acute sinusitis. 1414-1428 (1970). doi:10.1288/00005537-197009000-00007.

Ferguson M. P. & Mcnab A. A. Original Article Current treatment and outcome in orbital cellulitis. Aust. N. Z. J. Ophthalmol. 27, 375–379 (1999).

Ho C., Huang Y., Wang C., Chiu C. & Lin T. Clinical analysis of computed tomography-staged orbital cellulitis in children. J Microbiol Immunol Infect. 40, 518–524 (2007).

Skov R, F, Frimodt-Moller N, Espersen F. In vitro susceptibility of Staphylococcus aureus towards amoxyciUin-clavulanic acid, penicillin clavulanic acid, dicloxacillin and cefuroxime. Journal of Pathology, Microbiology, and Immunology. 110, 559-564 (2002)

Mathias M. T., Horsley M. B., Mawn,L. A. & Laquis S. J. Atypical Presentations of Orbital Cellulitis Caused by Methicillin-Resistant Staphylococcus aureus. Am. Acad. Ophthalmol. 119, 1238–1243 (2012).

Smith J. & Enzenauer R. Microbiology and Antibiotic Management of Orbital Cellulitis. Pediatrics 127, e566–e572 (2011).

Kadhiravan T., Piramanayagam P., Banga A., Gupta R. & Sharma S. K. Journal of Medical Case Reports with orbital cellulitis : a case report. J. Med. Case Rep. 4, 2–5 (2008).

Hauser A., Fogarasi S. & Hauser A. Periorbital and Orbital Cellulitis. Paediatr. Rev. 31, 241–250 (2010)

Downloads

Published

2019-12-18

Issue

Section

Journal of Biomedical and Clinical Sciences