Division of Orbital and Oculoplastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles.
Department of Ophthalmology, Children's Hospital, Los Angeles, California.
JAMA Ophthalmol. 2014 Aug;132(8):993-5. doi: 10.1001/jamaophthalmol.2014.965.
Although classically thought to be primarily a nosocomial infection, the incidence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is rising. In this series we report 3 cases of community-acquired MRSA acute dacryoadenitis in adults presenting within a 3-week period.
All cases presented with pain and periocular erythema increasing over approximately 1 week. An S-shaped lid deformity was evident, and 2 of the 3 cases demonstrated multiple pustules/abscesses in the region of the lacrimal gland that were expressing purulent fluid into the superior fornix. Eye cultures yielded MRSA. Each case had complete clinical resolution with 2 to 4 days of intravenous vancomycin followed by 1 week of oral trimethoprim-sulfamethoxazole combination therapy.
These cases underscore the changing profile of MRSA infections, especially in the community-based setting. MRSA dacryoadenitis can be difficult to treat with standard therapeutic approaches and may progress to orbital cellulitis. We recommend a short admission for intravenous antibiotic therapy while bacterial sensitivities are being determined before transitioning to a dual-targeted oral antibiotic regimen.
虽然耐甲氧西林金黄色葡萄球菌（MRSA）感染通常被认为主要是医院获得性感染，但社区获得性 MRSA 的发病率正在上升。在本系列中，我们报告了 3 例成人社区获得性 MRSA 急性泪腺炎，这些病例在 3 周内出现。
所有病例均表现为疼痛和眶周红斑逐渐加重，约 1 周。明显出现 S 形睑变形，其中 2 例病例在泪腺区域显示多个脓疱/脓肿，脓性分泌物排入上穹窿。眼部培养物检出 MRSA。所有病例均经静脉万古霉素治疗 2 至 4 天，然后口服复方磺胺甲噁唑 1 周，完全临床缓解。
这些病例突显了 MRSA 感染的变化模式，尤其是在社区环境中。MRSA 泪腺炎用标准治疗方法可能难以治疗，并可能进展为眶蜂窝织炎。我们建议在确定细菌敏感性期间住院接受静脉抗生素治疗，然后过渡到双靶向口服抗生素治疗方案。
