Comparison of Methicillin-Sensitive Staphylococcus Epidermidis (MSSE) Keratits and Methicillin-Resistant Staphylococcus Epidermidis (MRSE) Keratitis

PURPOSE: To investigate the clinical features and treatment outcomes between methicillin-sensitive Staphylococcus epidermidis (MSSE) and methicillin-resistant Staphylococcus epidermidis (MRSE) keratitis groups. METHODS: A retrospective analysis of case series was conducted of all patients with keratitis caused only by Staphylococcus epidermidis from January 1997 through December 2008. Sex, age, history of trauma, systemic disease, previous ocular history, antibiotic sensitivity test results, and treatment outcomes were evaluated. Patients were categorized into two groups as MSSE and MRSE according to methicillin-sensitivity result, and a comparative analysis was performed. RESULTS: There were no significant differences in clinical features, such as risk factors or size or location of keratitis between the two groups. All MSSE and MRSE isolates were sensitive to vancomycin, moxifloxacin, and levofloxacin. All MSSE and 17%, 50%, 52%, and 57% of MRSE isolates were sensitive to cephalothin, norfloxacin, ciprofloxacin, and erythromycin, respectively (p < 0.05). There was no significant difference in visual acuity between the two groups. CONCLUSIONS: All MSSE and MRSE isolates were sensitive to vancomycin and to third- or fourth-generation fluoroquinolones In addition, approximately 50% of MRSE isolates were sensitive to norfloxacin and ciprofloxacin. There were no significant differences in clinical features of keratitis caused by MSSE versus those of MRSE isolates. Both keratitis groups had relatively good visual prognoses.

Clinical Aspect and Prognosis of Staphylococcus Epidermidis Keratitis

PURPOSE: To investigate the predisposing factors, clinical manifestations, treatment results and risk factors for treatment failure in Staphylococcus epidermidis keratitis. METHODS: Sixty-one eyes of 61 patients who were diagnosed with Staphylococcus epidermidis keratitis were included in the present study. The past history, location and size of ulceration, hypopyon, treatment results, and antibiotic susceptibility were reviewed retrospectively. A logistic regression analysis was performed to identify the main prognostic risk factors for treatment failure. RESULTS: Twenty-six eyes (42.6%) had previous histories of corneal traumas. Polymicrobial infections were observed in 31 cases (50.8%), including 11 cases (35.5%) combined with the Fusarium species. Twenty-five eyes (41.0%) had lesions located at the corneal center. The average size of ulceration was 7.3 +/- 7.2 mm2. Thirteen eyes (21.3%) with lesions that progressed or occurred in the corneal perforation underwent evisceration, penetrating keratoplasty or scleral graft. Risk factors for treatment failure were a history of previous keratitis (P = 0.003) and an ulcer exceeding 5.0 mm2 in size (P = 0.018). CONCLUSIONS: Staphylococcus epidermidis keratitis usually has a good prognosis, although a history of previous keratitis and a large ulcer size are risk factors for treatment failure.

Epidemiology of Staphylococcus epidermidis Keratitis

PURPOSES: Staphylococcus epidermidis is a causative agent of bacterial keratitis and the authors performed an epidemiologic study to identify the risk factors, clinical features and treatment results. METHODS: Epidemiologic study on Staphylococcus epidermidis keratitis, which were confirmed by cultures in 6 university hospitals, was performed prospectively under the identical protocol. RESULTS: Seventeen cases of Staphylococcus epidermidis keratitis were diagnosed by culture with corneal scraping and comprised 4.1% of 401 cases of confirmed bacterial keratitis. Male patients were affected more than female patients and the highest prevalent age was in the seventies. Most of their occupation was farming. The most prevalent season was fall and it mostly occurred after corneal trauma. CONCLUSIONS: Staphylococcus epidermidis keratitis usually occurred in a relatively old age group followed by corneal trauma. Its prevention along with early and proper antimicrobial therapy based on sensitivity results is important.