Abstract
BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) infection is an important public health issue. The study aimed to characterize the patient demographics, clinical features, antibiotic susceptibility, and clinical outcomes of keratitis caused by S. aureus, and to make a comparison between MRSA and methicillin-sensitive S. aureus (MSSA) isolates.Methodology/Principal findingsPatients (n = 59) with culture-proven S. aureus keratitis treated in Chang Gung Memorial Hospital between January 1, 2006, and December 31, 2010, were included in our study. Patients' demographic and clinical data were retrospectively reviewed. Twenty-six MRSA (44%) and 33 MSSA (56%) isolates were collected. The MRSA keratitis was significantly more common among the patients with healthcare exposure (P = 0.038), but 46.2% (12/26) of patients with MRSA keratitis were considered to have community-associated infections. All isolates were susceptible to vancomycin. MRSA isolates were significantly more resistant to clindamycin, erythromycin, and sulfamethoxazole/trimethoprim. Ocular surface disease was a significant risk factor for MRSA keratitis (P = 0.011). Visual outcome did not differ significantly between the MRSA and MSSA groups. However, age (B = 0.01, P = 0.035, 95% confidence interval [CI]: 0.001–0.019) and visual acuity at presentation (B = 0.749, P<0.001, 95% CI: 0.573–0.926) were significantly correlated with visual outcome.Conclusions/SignificanceOcular surface disease is an important predisposing factor for S. aureus keratitis, especially for MRSA infections. Advanced age and poor visual acuity at presentation are important prognostic indicators for poor visual outcome in S. aureus keratitis. Oxacillin resistance may not be a significant prognostic indicator.
Highlights
Staphylococcus aureus is one of the most important pathogens in bacterial keratitis, a vision-threatening disease. [1,2] the incidence of S. aureus keratitis varies worldwide, the increasing trend of resistance to certain antibiotics makes this condition an important global healthcare issue. [3,4,5]Methicillin-resistant S. aureus (MRSA) is a term used to describe strains of S. aureus that are resistant to all b-lactam antibiotics
Our data showed that Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) contributed almost to S. aureus keratitis and nearly half of MRSA keratitis was community-associated
S. aureus, which accounts for approximately 8–22% of all bacterial keratitis, is an important cause of bacterial keratitis. [1,3,5,24,25] studies of the prevalence of MRSA keratitis are scant
Summary
Staphylococcus aureus is one of the most important pathogens in bacterial keratitis, a vision-threatening disease. [1,2] the incidence of S. aureus keratitis varies worldwide, the increasing trend of resistance to certain antibiotics makes this condition an important global healthcare issue. [3,4,5]. The emergence of MRSA strains is clinically relevant because their resistance to multiple antibiotics limits treatment options for MRSA infection. Considered a nosocomial pathogen, MRSA has reportedly increased in prevalence among otherwise healthy patients without identified risk factors. These infections are described as communityassociated MRSA (CA-MRSA) infections. [10,11,12,13,14,15] The scope of our previous studies on ocular MRSA infections was primarily focused on epidemiology and included a broad spectrum of diseases, so we did not intend to analyze clinical features and outcomes. We compared the clinical characteristics, predisposing factors, antibiotic susceptibility, treatment modalities, and visual outcome of patients with MRSA keratitis to those caused by methicillin-sensitive S. aureus (MSSA)
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