External ocular infections due to methicillin-resistant Staphylococcus aureus (MRSA)

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.

Staphylococcal Infection, Antibiotic Resistance and Therapeutics

“…The prevalence of MRSA in ocular infections varies in different studies. While it is reported to be as low as 3% in England (Shanmuganathan et al, 2005), it is high (25-64%) in Japan (Fukuda et al, 2002). However, Indian workers have also reported increasing prevalence of MRSA over the years (Bagga et al, 2010).…”

“…These authors showed decreased susceptibility to fluoroquinolones among MRSA from ocular infections. Shanmuganathan et al (2005) found the MRSA susceptible to chloramphenicol and gentamicin and resistant to third generation fluoroquinolones (ciprofloxacin and ofloxacin) and cefazolin. Topical administration of fortified cefazolin (5%) was recommended for the treatment of staphylococcal keratitis based on in vitro susceptibility of S. aureus and CoNS (Sharma et al, 1999, Sharma et al, 2004.…”

Methicillin-Resistant Staphylococcus aureus and the Eye: Current Concepts and Management Strategies

“…The MRSA prevalence rate increased 12.1 % during the 5-year period (from 29.5 % in 2000 to 41.6 % in 2005) [114]. Amato et al [93] Small case series (based on microbiology results or drug trials) Shanmuganathan et al [123] Rutar et al [91] Adebayo et al [124] Lichtinger et al [95] Sotonzono et al [118] Case reports site-specific Lacrimal system Kotlus et al [90] Rutar [107] Kubal and Garibaldi [105] Chandravanshi et al [106] Gould et al [125] Conjunctiva Tarabishy et al [85] Cimolai [61] Ikeda et al [119] Mantadakis et al [113] Cellulitis Mehra et al [98] Charalampidou et al [99] Juthani et al [101] Vaska et al [104] Soon [100] Mathias et al [102] Endophthalmitis Deramo et al [96] Major et al [97] Ursea et al [126] Ho et al [86] Basu et al [62] Keratitis Sotozono et al [67] Lee et al [69] Chou et al [65] Post-surgical case reports Cataract surgery Cosar et al [75] Tang et al [70] Retinal surgery Oshima et al [68] Feiz and Redline [72] Rich et al [74] Pterygium surgery Lee et al [73] Curr…”

Recurrent hypopyon due to methicillin-resistant Staphylococcus aureus after cataract surgery

“…Clinicians may need to re-evaluate antibiotic regimens in endemic areas, keeping in mind that MRSA remains susceptible to vancomycin and chloramphenicol but is often resistant to ciprofloxacin. 2,5 …”

“…1 Patients often have ocular surface disease, atopy, or a debilitating illness. 5 Our patient had been previously hospitalised for major bowel surgery.…”