title: Methicillin resistance of Staphylococcus species among health care and nonhealth care workers undergoing cataract surgery.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: The John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA. randallj.olson@hsc.utah.edu
authors.forename: Randall
authors.initials: R
authors.lastname: Olson
authors.forename: Eric
authors.initials: E
authors.lastname: Donnenfeld
authors.forename: Frank A
authors.initials: FA
authors.lastname: Bucci
authors.forename: Francis W
authors.initials: FW
authors.lastname: Price
authors.forename: Michael
authors.initials: M
authors.lastname: Raizman
authors.forename: Kerry
authors.initials: K
authors.lastname: Solomon
authors.forename: Uday
authors.initials: U
authors.lastname: Devgan
authors.forename: William
authors.initials: W
authors.lastname: Trattler
authors.forename: Steven
authors.initials: S
authors.lastname: Dell
authors.forename: R Bruce
authors.initials: RB
authors.lastname: Wallace
authors.forename: Michelle
authors.initials: M
authors.lastname: Callegan
authors.forename: Heather
authors.initials: H
authors.lastname: Brown
authors.forename: Peter J
authors.initials: PJ
authors.lastname: McDonnell
authors.forename: Taryn
authors.initials: T
authors.lastname: Conway
authors.forename: Rhett M
authors.initials: RM
authors.lastname: Schiffman
authors.forename: David A
authors.initials: DA
authors.lastname: Hollander