title: Staphylococcus aureus ocular infection: methicillin-resistance, clinical features, and antibiotic susceptibilities.
abstract: BACKGROUND
  Methicillin-resistant Staphylococcus aureus (MRSA) infection is an important public health issue. The study aimed to determine the prevalence of ocular infections caused by MRSA and to identify the clinical characteristics and antibiotic susceptibility of ocular MRSA infections by comparing those of ocular methicillin-sensitive S. aureus (MSSA) infections.
  
  
  RESULTS
  The medical records of the patients (n = 519) with culture-proven S. aureus ocular infections seen between January 1, 1999 and December 31, 2008 in Chang Gung Memorial Hospital were retrospectively reviewed. Two hundred and seventy-four patients with MRSA and 245 with MSSA ocular infections were identified. The average rate of MRSA in S. aureus infections was 52.8% and the trend was stable over the ten years (P value for trend  = 0.228). MRSA ocular infections were significantly more common among the patients with healthcare exposure (P = 0.024), but 66.1% (181/274) patients with MRSA ocular infections had no healthcare exposure. The most common clinical presentation for both MRSA and MSSA ocular infections was keratitis; MRSA and MSSA caused a similar disease spectrum except for lid infections. MRSA was significantly more resistant than MSSA to clindamycin, erythromycin and sulfamethoxazole/trimethoprim (all P<0.001).
  
  
  CONCLUSIONS
  We demonstrated a paralleled trend of ocular MRSA infection in a highly prevalent MRSA country by hospital-based survey. Except for lid disorder, MRSA shared similar spectrum of ocular pathology with MSSA. Since S. aureus is a common ocular pathogen, our results raise clinician's attention to the existence of highly prevalent MRSA.
authors.affiliation: Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: Chih-Chun
authors.initials: CC
authors.lastname: Chuang
authors.forename: Ching-Hsi
authors.initials: CH
authors.lastname: Hsiao
authors.forename: Hsin-Yuan
authors.initials: HY
authors.lastname: Tan
authors.forename: David Hui-Kang
authors.initials: DH
authors.lastname: Ma
authors.forename: Ken-Kuo
authors.initials: KK
authors.lastname: Lin
authors.forename: Chee-Jen
authors.initials: CJ
authors.lastname: Chang
authors.forename: Yhu-Chering
authors.initials: YC
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use; D004917:Erythromycin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007634:Keratitis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D013211:Staphylococcus aureus / Q000472:pathogenicity; D013420:Sulfamethoxazole / Q000627:therapeutic use; D014295:Trimethoprim / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D004917:Erythromycin; D014295:Trimethoprim; D013420:Sulfamethoxazole