Abstract
BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) infection is an important public health issue. The study aimed to determine the prevalence of ocular infections caused by MRSA and to identify the clinical characteristics and antibiotic susceptibility of ocular MRSA infections by comparing those of ocular methicillin-sensitive S. aureus (MSSA) infections.Methodology/Principal FindingsThe medical records of the patients (n = 519) with culture-proven S. aureus ocular infections seen between January 1, 1999 and December 31, 2008 in Chang Gung Memorial Hospital were retrospectively reviewed. Two hundred and seventy-four patients with MRSA and 245 with MSSA ocular infections were identified. The average rate of MRSA in S. aureus infections was 52.8% and the trend was stable over the ten years (P value for trend = 0.228). MRSA ocular infections were significantly more common among the patients with healthcare exposure (P = 0.024), but 66.1% (181/274) patients with MRSA ocular infections had no healthcare exposure. The most common clinical presentation for both MRSA and MSSA ocular infections was keratitis; MRSA and MSSA caused a similar disease spectrum except for lid infections. MRSA was significantly more resistant than MSSA to clindamycin, erythromycin and sulfamethoxazole/trimethoprim (all P<0.001).Conclusions/significanceWe demonstrated a paralleled trend of ocular MRSA infection in a highly prevalent MRSA country by hospital-based survey. Except for lid disorder, MRSA shared similar spectrum of ocular pathology with MSSA. Since S. aureus is a common ocular pathogen, our results raise clinician’s attention to the existence of highly prevalent MRSA.
Highlights
Staphylococcus aureus is among the most important and commonly isolated human bacterial pathogens
We conducted a 10-year retrospective study to determine the rate of ocular Methicillin-resistant Staphylococcus aureus (MRSA) infections and to identify the clinical characteristics and antibiotic susceptibility of ocular MRSA infection by comparing those of ocular methicillin sensitive S. aureus (MSSA) infections seen in Chang Gung Memorial Hospital, a 3000-bed tertiary referral hospital in Taiwan
Ninety three patients (93/274, 33.9%) with MRSA ocular infections and 60 patients (60/245, 24.5%) with methicillin-sensitive S. aureus (MSSA) ocular infections had healthcare exposure; MRSA infections were significant more common among the patients with healthcare exposure (P = 0.024)
Summary
Staphylococcus aureus is among the most important and commonly isolated human bacterial pathogens. [8,9,10,11,12,13,14,15,16,17,18] Case series of catastrophic eye infections caused by MRSA has been reported recently in patients after refractive and cataract surgery. [8,9,10] The Surveillance Network, which monitors antimicrobial susceptibility patterns of bacterial pathogens in the United States, reported an increase in the proportion of MRSA among S. aureus ocular infections, from. [12] In Taiwan, the rate of MRSA among S. aureus clinical isolates, was about 60% during 1997–2000, [20,21] a rate higher than that reported in other regions of the world, [20] but the rate of ocular infections caused by MRSA remains unknown. We conducted a 10-year retrospective study to determine the rate of ocular MRSA infections and to identify the clinical characteristics and antibiotic susceptibility of ocular MRSA infection by comparing those of ocular methicillin sensitive S. aureus (MSSA) infections seen in Chang Gung Memorial Hospital, a 3000-bed tertiary referral hospital in Taiwan
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