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Methicillin resistance of Staphylococcus species among health care and nonhealth care workers undergoing cataract surgery

Authors Olson R, Donnenfeld ED, Bucci Jr. F, Price F, Raizman M, Solomon K, Devgan, Trattler W, Dell S, Wallace RB, Callegan M, Brown H, McDonnell P, Conway T, Schiffman RM, Hollander D

Published 10 December 2010 Volume 2010:4 Pages 1505—1514


Review by Single-blind

Peer reviewer comments 3

Randall Olson1, Eric Donnenfeld2, Frank A Bucci Jr3, Francis W Price Jr4, Michael Raizman5, Kerry Solomon6, Uday Devgan7, William Trattler8, Steven Dell9, R Bruce Wallace10, Michelle Callegan11, Heather Brown11, Peter J McDonnell12, Taryn Conway13, Rhett M Schiffman13, David A Hollander13
1The John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA; 2Ophthalmic Consultants of Long Island and Connecticut, Rockville Centre, NY, USA; 3Bucci Laser Vision Institute, Wilkes-Barre, PA, USA; 4Price Vision Group, Indianapolis, IN, USA; 5Ophthalmic Consultants of Boston, Boston, MA, USA; 6Department of Ophthalmology, Medical University of South Carolina, Charleston, SC, USA; 7Maloney Vision Institute, Los Angeles, CA, USA; 8Center for Excellence in Eye Care, Miami, FL, USA; 9Dell Laser Consultants, Austin, TX, USA; 10Wallace Eye Surgery, Laser and Surgery Center, Alexandria, LA, USA; 11Department of Ophthalmology, University of Oklahoma Health Sciences Center, Dean A. McGee Eye Institute, Oklahoma City, OK, USA; 12Wilmer Eye Institute, the Johns Hopkins University School of Medicine, Baltimore, MD, USA; 13Allergan Inc., Irvine, CA, USA

Purpose: The purpose of this study is to characterize the bacterial flora of the ocular and periocular surface in cataract surgery patients and to determine the prevalence of methicillin resistance among staphylococcal isolates obtained from health care workers (HCWs) and non-HCWs.
Methods: In this prospective, multicenter, case series study, eyelid and conjunctival cultures were obtained from the nonoperative eye of 399 consecutive cataract patients on the day of surgery prior to application of topical anesthetics, antibiotics, or antiseptics. Speciation and susceptibility testing were performed at the Dean A. McGee Eye Institute. Logistic regression was utilized to evaluate whether any factors were significant in predicting the presence of methicillin-resistant staphylococcal isolates.
Results: Staphylococcus epidermidis (62.9%), followed by S. aureus (14.0%), was the most frequently isolated organism. Methicillin-resistant S. epidermidis accounted for 47.1% (178/378) of S. epidermidis isolates, and methicillin-resistant S. aureus accounted for 29.5% (26/88) of S. aureus isolates. Methicillin-resistant staphylococcal isolates were found in 157 of 399 (39.3%) patients, the majority (89.2%) of whom were non-HCWs. The likelihood of being colonized with methicillin-resistant organisms increased with age (odds ratio [OR], 1.27; 95% confidence interval [CI]: 1.02–1.58; P = 0.04) but decreased with diabetes (OR, 0.51; 95% CI: 0.29–0.89; P = 0.02). Being a HCW (OR, 1.25; 95% CI: 0.61–2.58; P = 0.54) was not a risk factor for colonization with methicillin-resistant organisms.
Conclusion: Patients without exposure to health care environments are as likely as HCWs to be colonized with methicillin-resistant organisms. Increasing methicillin resistance with age may partially explain the increased risk of endophthalmitis reported with older age.

Keywords: age, bacterial flora, cataract surgery, methicillin resistance, ocular and periocular surface, Staphylococci

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