Abstract
Purpose
To determine the prevalence and clinical characteristics of external ocular infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in an ophthalmic hospital in the UK.
Methods
A retrospective analysis of the case notes of patients who had culture proven external ocular Staphylococcal infections during a 44-month period was undertaken.
Results
There were a total of 548 external eye infections caused by Staphylococcus aureus. Of these, 17 (3%) were MRSA positive. The most common presentation was conjunctivitis seen in six patients. All MRSA isolates were sensitive to chloramphenicol. Ofloxacin resistance was observed in all isolates from patients over the age of 50 years. All patients had an underlying history of either an ocular surface disease, malignancy, or a debilitating medical illness.
Conclusions
MRSA is as yet an infrequent cause of external ocular infections. Patients typically have underlying ocular risk factors and/or are medically debilitated. Different strains infect young and old age groups with characteristic antimicrobial sensitivity. This study highlights the need for more work to establish the role of MRSA commensals and ocular infections.
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References
Hryniewicz W . Epidemiology of MRSA. Infection 1999; 27 (Suppl. 2): S13–S15.
Van Belkum A, Verbrugh H . 40 years of methicillin-resistant Staphylococcus aureus. BMJ 2001; 323: 644–645.
Working Party of the British Society of Antimicrobial Chemotherapy, Hospital Infection Society and Infection Control Nurses Association. Revised guidelines for the control of methicillin-resistant Staphylococcus aureus. J Hosp Infect 1998; 39: 253–290.
Simcock PR, Butcher JM, Armstrong M, Lloyd IC, Tullo AB . Investigation of microbial keratitis: an audit from 1988–1992. Acta Ophthalmol Scand 1996; 74: 183–186.
Andrews JM . The development of the BSAC standardised method of disc diffusion testing. J Antimicrob Chemother 2001; 48 (Suppl.1): 29–42.
Sotozono C, Inagaki K, Fujita A, Koizumi N, Sano Y, Inatomi T et al. Methicillin-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus epidermidis infections in the cornea. Cornea 2002; 21 (Suppl. 2): S94–S101.
Fukuda M, Ohashi H, Matsumoto C, Mishima S, Shimomura Y . Methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococcus ocular surface infection. Cornea 2002; 21 (Suppl. 2): S86–S89.
Tazawa H, Ooishi M . MRSA ocular infections. Nippon Rinsho 1992; 50: 1122–1126, (in Japanese).
Miedziak AI, Miller MR, Rapuano CJ, Laibson PR, Cohen EJ . Risk factors in microbial keratitis leading to penetrating keratoplasty. Ophthalmology 1999; 106: 1166–1171.
Horil T, Futamura N, Suzuki Y . Antiseptic treatment of methicillin-resistant Staphyloccocus aureus conjunctivitis. J Infect 2001; 42: 166–169.
Doona M, Walsh JB . Use of chloramphenicol as topical eye medication: time to cry halt? BMJ 1995; 310: 1217–1218.
Hiramatsu K, Aritaka N, Hanaki H, Kawasaki S, Hosoda Y, Hori S et al. Dissemination in Japanese hospitals of strains of Staphylococcus aureus heterogeneously resistant to vancomycin. Lancet 1997; 350: 1670–1673.
Brennen C, Muder RR . Conjunctivitis associated with methicillin-resistant Staphlococcus aureus in a long-term care facility. Am J Med 1990; 88 (5N): 14N–17N.
Rubinfeld RS, Negvesky GJ . Methicillin-resistant Staphylococcus aureus ulcerative keratitis after in situ keratomileusis. J Cataract Refract Surg 2001; 27: 1523–1525.
Rudd JC, Moshirfar M . Methicillin-resistant Staphylococcus aureus keratitis after laser in situ keratomileusis. J Cataract Refract Surg 2001; 27: 471–473.
Förster W, Becker K, Hungermann D, Busse H . Methicillin-resistant Staphylococcus aureus ulcerative keratitis after excimer laser photorefractive keratectomy. J Cataract Refract Surg 2002; 28: 722–724.
Donnenfeld ED, O’Brien TP, Solomon R, Perry HD, Speaker MG, Wittpenn J . Infectious keratitis after photorefractive keratectomy. Ophthalmology 2003; 110: 743–747.
Naylor AR, Hayes PD, Darke S . A prospective audit of complex wound and graft infections in Great Britain and Ireland: the emergence of MRSA. Eur J Vasc Endovasc Surg 2001; 21: 289–294.
Watanabe K, Numata-Watanabe K, Hayasaka S . Methicillin-resistant Staphylococci and ofloxacin-resistant bacteria from clinically healthy conjunctivas. Ophthalmic Res 2001; 33: 136–139.
Kato T, Hayasaka S . Meticillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococci from conjunctivas of preoperative patients. Jpn J Ophthalmol 1998; 42: 461–465.
Ribner BS . Endemic, multiply resistant Staphylococcus aureus in a pediatric population. Clinical description and risk factors. Am J Dis Child 1987; 141: 1183–1187.
Ross J, Abate MA . Topical vancomycin for the treatment of Staphylococcus epidermidis and methicillin-resistant Staphylococcus aureus conjunctivitis. DICP 1990; 24: 1050–1053.
Insler MS, Fish LA, Silbernagel J, Hobden JA, O’Callaghan RJ, Hill JM . Successful treatment of methicillin resistant Staphylococcus aureus keratitis with topical ciprofloxacin. Ophthalmology 1991; 98: 1690–1692.
Eiferman RA, O’Neill KP, Morrison NA . Methicillin- resistant Staphylococcus aureus corneal ulcers. Ann Ophthalmol 1991; 23: 414–415.
Muder RR, Brennen C, Goetz AM . Infection with methicillin- resistant Staphlococcus aureus amoung hospital employees. Infect Control Hosp Epidemiol 1993; 14: 576–578.
Mitsuda T, Arai K, Fujita S, Yokota S . Epidemiological analysis of strains of methicillin-resistant Staphylococcus aureus (MRSA) infection in the nursery; prognosis of MRSA carrier infants. J Hosp Infect 1995; 31: 123–134.
Spindel SJ, Strausbaugh LJ, Jacobson C . Infections caused by Staphylocoocus Aureus in a veterans affairs nursing home care unit: a 5-year experience. Infect Control Hosp Epidemiol 1995; 16: 217–223.
Jernigan JA, Titus MG, Groschel DH, Getchell-White SI, Farr BM . Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus. Am J Epidemiol 1996; 143: 496–504.
Saitoh A, Jinbayashi H, Saitoh AK, Ohira A, Amemiya T, Etoh K et al. Parameter estimation and dosage adjustment in the treatment with vancomycin of methicillin-resistant Staphylococcus aureus ocular infections. Ophthalmologica 1999; 211: 232–235.
Oshima Y, Ohji M, Inoue Y, Harada J, Motokura M, Saito Y et al. Methicillin-resistant Staphylococcus aureus infections after scleral buckling procedures for retinal detachments associated with atopic dermatitis. Ophthalmology 1999; 106: 142–147.
Cosar CB, Cohen EJ, Rapuano CJ, Laibson PR . Clear corneal wound infection after phacoemulsification. Arch Ophthalmol 2001; 119: 1755–1759.
Kubo M, Sakuraba T, Arai Y, Nakazawa M . Dacryocystorhinostomy for dacryocystitis caused by methicillin-resistant Staphylococcus aureus: report of four cases. Jpn J Ophthalmol 2002; 46: 177–182.
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This study was presented in part as a poster at The Royal College of Ophthalmologists Annual Congress, Manchester, UK, May 2002.
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Shanmuganathan, V., Armstrong, M., Buller, A. et al. External ocular infections due to methicillin-resistant Staphylococcus aureus (MRSA). Eye 19, 284–291 (2005). https://doi.org/10.1038/sj.eye.6701465
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DOI: https://doi.org/10.1038/sj.eye.6701465
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