Drug-resistant bacteria can complicate treatment after many surgical procedures. In particular, Methicillin-resistant Staphylococcus aureus (MRSA), which has been found in many healthcare settings, can be a serious post-operative complication. In a study published in the April issue of the American Journal of Ophthalmology, researchers found MRSA infections in the eyes of 12 patients after refractive surgery.
These are the first cases of MRSA infectious keratitis following refractive surgery, the first reports of MRSA keratitis after refractive surgery in patients with no known exposure to a healthcare facility, the first report of MRSA keratitis after a laser in situ keratomileusis (LASIK) enhancement, and the first reports of MRSA keratitis after prophylaxis with fourth generation fluoroquinolones.
Colonization of MRSA has been found in 1.5% of the general population, but as many as 9.4% of those were exposed to a healthcare facility. However, strains of MRSA are emerging in the community. These so-called community strains tend to be resistant only to beta-lactam antibiotics, unlike the hospital strains, which usually demonstrate multiple drug resistance. Community-acquired MRSA is becoming a significant problem, with the prevalence of MRSA among community isolates expected to reach as high as 25% in the next decade.
The authors cite the case of a male nurse who underwent an "uneventful" bilateral LASIK procedure that resulted in 20/20 (right eye) and 20/70 (left eye) visual acuity. Within 2 weeks, he had developed an infection in his left eye that grew worse, despite treatment, until his vision was only 20/400. When the infection was cultured and found to be MRSA, his antibiotics were changed and his vision recovered to 20/200 over the next two weeks. The patient is awaiting further surgical treatment.
Writing in the article, Eric D. Donnenfeld, MD, advises that, "MRSA infectious keratitis is a potentially serious complication following refractive surgery. Healthcare workers may develop keratitis from microbes associated with nosocomial infection. In addition, surgeons should now be vigilant for community-acquired MRSA keratitis. All patients should be informed of the risk factors and warning signs of infectious keratitis and need to be advised to seek medical attention immediately if they develop signs or symptoms of infectious keratitis. A high degree of suspicion, coupled with prompt and appropriate treatment, may result in improved visual recovery."
The article is "Methicillin-Resistant Staphylococcus aureus Infectious Keratitis Following Refractive Surgery" by Renée Solomon, MD, Eric D. Donnenfeld, MD, Henry D. Perry, MD, Roy S. Rubinfeld, MD, Michael Ehrenhaus, MD, John R. Wittpenn, Jr, MD, Kerry D. Solomon, MD, Edward E. Manche, MD, Majid Moshirfar, MD, Dennis C. Matzkin, MD, Reza M. Mozayeni, MD, and Robert K. Maloney, MD.
The authors are affiliated with Ophthalmic Consultants of Long Island, Rockville Centre, New York (R.S., E.D.D., H.D.P., J.R.W.); Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, New York (E.D.D.); Washington Eye Physicians and Surgeons, Chevy Chase, Maryland; and Georgetown University Medical Center, and the Washington Hospital Center, Washington, DC (R.S.R.); Saint Vincent Catholic Medical Center of Brooklyn and Queens, St Joseph’s Hospital, Flushing, New York (M.E.); Department of Ophthalmology, State University of New York at Stony Brook, Stony Brook, New York (J.R.W.); Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina (K.D.S.); Department of Ophthalmology, Stanford University School of Medicine, Stanford, California (E.E.M.); Moran Eye Center, University of Utah, Salt Lake City, Utah (M.M.); EyeSight Laser Center, Atlanta, Georgia (D.C.M.); Providence Eye and Laser Specialists, Charlotte, North Carolina (R.M.M.); and Maloney Vision Institute, Los Angeles, California (R.K.M.).
The article appears in the American Journal of Ophthalmology, Volume 143, Issue 4, (April 2007), and is published by Elsevier.
Journal
American Journal of Ophthalmology