Outcomes of Staphylococcus aureus Keratitis: A Retrospective Comparison of Methicillin-Resistant and Methicillin-Susceptible Isolates
Abstract
Purpose: To describe the clinical characteristics, antimicrobial susceptibility profiles, treatment patterns, and outcomes of methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) Staphylococcus aureus keratitis.
Methods: Staphylococcus aureus isolates from corneal scrapings were collected between 2004 and 2022 at 2 tertiary centers in Vancouver, Canada, and Boston, USA. Antibiotic susceptibility profiles were recorded, and demographic data, ocular and systemic risk factors, treatment regimens, and clinical outcomes were retrospectively analyzed and compared between MRSA and MSSA keratitis cases.
Results: A total of 174 patients with culture-proven S. aureus keratitis were included, comprising 104 MSSA (59.8%) and 70 MRSA (40.2%) cases. Median age was 63.5 years, and ocular surface disease was the most common local risk factor (64.5%). The cohort showed a high burden of systemic comorbidities and health care exposure in the preceding year (44.8%), with MRSA keratitis significantly associated with prior MRSA infection (P < 0.001) and intubation or sedation (P = 0.007). MRSA isolates had low susceptibility to fluoroquinolones (moxifloxacin 19.7%) but remained uniformly susceptible to vancomycin. Vancomycin-containing regimens predominated in both groups, commonly combined with tobramycin (52.3%). Overall visual outcomes were poor (median final BCVA 1.30 logMAR), and surgical intervention was needed in 31.6% of cases. MSSA achieved significantly better final visual…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 174 participants or records.
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