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Persistence and Prevalence of MRSA on Ocular Surface
following Primary MSSA/MRSA Infections
Darlene Miller, DHSc, MPH, CICDavid Almeida, MD, PhDEduardo C. Alfonso, MD
The authors have no financial interest in the subject matter of this poster.
IntroductionStaphylococcus aureus remains the most common
ocular pathogen recovered from ocular infections at our Institute.
Colonization and persistent S. aureus infections can lead to chronic inflammation and severe ocular surface disease. 43.5
21.8
10.6
4.2
19.8
0
10
20
30
40
50
conjunctivitis keratitis blepharitis endopthalimitis All ocular
%
S. aureus
Ocular Sources-BPEI 1990-June 2009,
PurposeTo document the prevalence and
persistence of (MRSA) colonization following primary S. aureus infections.
To identify presister populations.
To document changes in in vitro susceptibility to vancomycin among patients with chronic MRSA infections.
MethodsReview of all MRSA Culture Positive Cases -
1990-June 2009 Colonizer= Patient with repeat MRSA positive
culture after a treatment course of at least 10 days.
Patient DemographicsAgeSexPresenting Clinical Diagnosis
Review and comparison of Vancomycin MICs
RESULTSMRSA Trends-All Ocular-1990-June 2009
8
14
28
38
0
5
10
15
20
25
30
35
40
1990-1994 1995-1999 2000-2004 2005-Jun2009
%
MRSA (N=651/2698, 24.1%)
Prevalence of MRSA Colonization/Persistence
7
98
12
0
2
4
6
8
10
12
14
1990-1994 1995-1999 2000-2004 2005-Jun2009
%
Colonizers (N=50, 7.7%)
Persistent MRSA Colonization Profile
70
1812
0
10
20
30
40
50
60
70
80
MRSA-MRSA MSSA-MRSA MRSA-MSSA
%
Colonization Profile
22%, 11/50 had 3 or more positive cultures
Demographics-Age/Sex (N=50)Female = 54%Males = 46%
32
12
64
16
1210
8
05
1015
2025
3035
<= 20 yrs 21-40 yrs 31-60 yr >60 yrs
%
females males
Clinical Diagnosis-Persistent MRSA Colonizers (N=50)
4
8
12
24
52
0 10 20 30 40 50 60
endophthalmitis
keratoconjunctivitis
dacryocystitis
keratitis
conjunctivitis
%
Presenting diagnosis
Change in Vancomycin MIC Among Repeat MRSA Isolates
0
10
20
30
40
50
60
70
Increased 2X Increased 4X Decreased1/2X
No Change
% c
ha
ng
e
Vancomycin MIC
24% increase in vancomycin MIC, (100% susceptible)
SummaryMRSA rates increased from 8% at baseline
(1990-1994) to 38% in the last 4.5 years (2005-June 2009).
Persistent MRSA colonization remain stable over the 19 year period (7.7%).
Persistent MRSA was more frequently recovered from conjunctivitis and women >60 yrs.
24% of repeat MRSA isolates demonstrated increased Vancomycin MICs
Clinical RelevanceColonization or Persistent MRSA on the
ocular surface can serve as:
Reservoir/foci for post surgical infections.
Antigenic trigger for increased/chronic inflammation.
Repeat or persistent MRSA isolation may impact in vivo efficacy of vancomycin.