A Comparison of Clinical Features between Community-Associated and Healthcare-Associated Methicillin-Resistant Staphylococcus aureus Keratitis.

Ching-Hsi Hsiao,David H K Ma,Sherine Jue Ong,Chih-Chun Chuang,Yhu-Chering Huang

doi:10.1155/2015/923941

Abstract

Purpose. To compare the clinical features of community-associated (CA) and healthcare-associated (HA) methicillin-resistant Staphylococcus aureus (MRSA) keratitis. Methods. Patients presenting with culture-proven MRSA keratitis between January 1, 2006, and December 31, 2010, at Chang Gung Memorial Hospital, Taiwan, were included in this study. The patients' demographic and clinical information were reviewed retrospectively. Antibiotic susceptibility was verified using the disk diffusion method. Results. Information on 26 patients with MRSA keratitis was collected, including 12 cases of CA-MRSA and 14 cases of HA-MRSA. All MRSA isolates were susceptible to vancomycin; the only difference in drug susceptibility was that CA-MRSA isolates were more susceptible to trimethoprim/sulfamethoxazole than HA-MRSA (P = .034). The most common risk factor for MRSA keratitis was ocular surface disease. No significant differences were observed between the 2 groups in terms of clinical features, treatments, and visual outcomes. Conclusion. In Taiwan, CA-MRSA rivals HA-MRSA as a critical cause of MRSA keratitis. Furthermore, CA-MRSA isolates are multidrug resistant. CA-MRSA and HA-MRSA keratitis are clinically indistinguishable, although larger studies are warranted to further evaluate this association.

Highlights

Staphylococcus aureus is among the most important and commonly isolated human bacterial pathogens
CA-methicillin-resistant S. aureus (MRSA) may have a distinct impact on patient outcomes in comparison with healthcare-associated MRSA (HA-MRSA), because most community-associated MRSA (CA-MRSA) isolates Journal of Ophthalmology have special intrinsic virulence factors, such as Panton-Valentine leukocidin (PVL) genes, and less resistance to antibiotics
In our previous 10-year study of MRSA ocular infections, we found that the most common ocular diseases caused by MRSA were keratitis, followed by lid disorder and conjunctivitis [19]

Summary

Introduction

Staphylococcus aureus is among the most important and commonly isolated human bacterial pathogens. MRSA, first identified in the 1960s, was traditionally associated with healthcare facilities, but its prevalence has reportedly increased in otherwise healthy patients without identified risk factors Such infections are called community-associated MRSA (CA-MRSA), and they are clinically, microbiologically, and genetically distinct from healthcare-associated MRSA (HA-MRSA) [1]. CA-MRSA strains primarily involve infection of the skin and soft tissues, and they occasionally cause severe diseases [2]. They are frequently susceptible to other antistaphylococcal agents and carry genes for Panton-Valentine leukocidin (PVL) and may present a new acquisition of type IV or V staphylococcal cassette chromosome mec (SCCmec) DNA [1, 3, 4]. We sought to determine whether keratitis caused by the different MRSA isolates had distinct outcomes

Materials and Methods

Results

Findings

Discussion

Conclusion