Successful treatment of methicillin-resistant Staphylococcus aureus infection associated with Jones tube using vancomycin eye drops and rifampicin

Abstract Objective Complications associated with the lacrimal Lester Jones tube have been reported. The infections associated with the tube and proper treatment are not well known. The authors have introduced a successful treatment regimen for persistent methicillin-resistant Staphylococcus aureus (MRSA) periocular infection associated with the lacrimal Lester Jones tube without tube removal. Design Retrospective case series. Participants Six patients with MRSA infection associated with the Lester Jones tube without tube removal. Methods Four patients had improper tube position with total regurgitation and 2 patients had relative normal tube position with a partial to normal passage, but the tube tip irritated the nasal mucosa wound persistently. In all 6 cases, development of a biofilm on the tube was observed. All cultures were positive for MRSA. Results All patients were prescribed a combination therapy of topical ocular vancomycin and oral rifampicin before or after the dislocated tube reposition. Periocular symptoms resolved within 1 week, and the biofilm on the tube was gradually reduced during combination therapy. Signs of recurrence of infection were not noted during the follow-up visits. Conclusion Patients showing infection signs associated with the Jones tube need to be examined before complete removal of the infected tube. Medical treatment with vancomycin eye drops combined with oral rifampicin for persistent MRSA infection associated with the Lester Jones tube produced a successful result. Removal of the biofilm on the tube at follow-up visits is important to prevent micro-organisms from dispersing around the tissue. If the Jones tube is dislocated, repositioning is highly recommended to prevent periocular MRSA infection recurrence.