persistence and prevalence of mrsa on ocular surface following primary mssa/mrsa infections darlene...

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Persistence and Prevalence of MRSA on Ocular Surface following Primary MSSA/MRSA Infections Darlene Miller, DHSc, MPH, CIC David Almeida, MD, PhD Eduardo C. Alfonso, MD The authors have no financial interest in the subject matter of this poster.

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Page 1: Persistence and Prevalence of MRSA on Ocular Surface following Primary MSSA/MRSA Infections Darlene Miller, DHSc, MPH, CIC David Almeida, MD, PhD Eduardo

Persistence and Prevalence of MRSA on Ocular Surface

following Primary MSSA/MRSA Infections

Darlene Miller, DHSc, MPH, CICDavid Almeida, MD, PhDEduardo C. Alfonso, MD

The authors have no financial interest in the subject matter of this poster.

Page 2: Persistence and Prevalence of MRSA on Ocular Surface following Primary MSSA/MRSA Infections Darlene Miller, DHSc, MPH, CIC David Almeida, MD, PhD Eduardo

IntroductionStaphylococcus aureus remains the most common

ocular pathogen recovered from ocular infections at our Institute.

Colonization and persistent S. aureus infections can lead to chronic inflammation and severe ocular surface disease. 43.5

21.8

10.6

4.2

19.8

0

10

20

30

40

50

conjunctivitis keratitis blepharitis endopthalimitis All ocular

%

S. aureus

Ocular Sources-BPEI 1990-June 2009,

Page 3: Persistence and Prevalence of MRSA on Ocular Surface following Primary MSSA/MRSA Infections Darlene Miller, DHSc, MPH, CIC David Almeida, MD, PhD Eduardo

PurposeTo document the prevalence and

persistence of (MRSA) colonization following primary S. aureus infections.

To identify presister populations.

To document changes in in vitro susceptibility to vancomycin among patients with chronic MRSA infections.

Page 4: Persistence and Prevalence of MRSA on Ocular Surface following Primary MSSA/MRSA Infections Darlene Miller, DHSc, MPH, CIC David Almeida, MD, PhD Eduardo

MethodsReview of all MRSA Culture Positive Cases -

1990-June 2009 Colonizer= Patient with repeat MRSA positive

culture after a treatment course of at least 10 days.

Patient DemographicsAgeSexPresenting Clinical Diagnosis

Review and comparison of Vancomycin MICs

Page 5: Persistence and Prevalence of MRSA on Ocular Surface following Primary MSSA/MRSA Infections Darlene Miller, DHSc, MPH, CIC David Almeida, MD, PhD Eduardo

RESULTSMRSA Trends-All Ocular-1990-June 2009

8

14

28

38

0

5

10

15

20

25

30

35

40

1990-1994 1995-1999 2000-2004 2005-Jun2009

%

MRSA (N=651/2698, 24.1%)

Page 6: Persistence and Prevalence of MRSA on Ocular Surface following Primary MSSA/MRSA Infections Darlene Miller, DHSc, MPH, CIC David Almeida, MD, PhD Eduardo

Prevalence of MRSA Colonization/Persistence

7

98

12

0

2

4

6

8

10

12

14

1990-1994 1995-1999 2000-2004 2005-Jun2009

%

Colonizers (N=50, 7.7%)

Page 7: Persistence and Prevalence of MRSA on Ocular Surface following Primary MSSA/MRSA Infections Darlene Miller, DHSc, MPH, CIC David Almeida, MD, PhD Eduardo

Persistent MRSA Colonization Profile

70

1812

0

10

20

30

40

50

60

70

80

MRSA-MRSA MSSA-MRSA MRSA-MSSA

%

Colonization Profile

22%, 11/50 had 3 or more positive cultures

Page 8: Persistence and Prevalence of MRSA on Ocular Surface following Primary MSSA/MRSA Infections Darlene Miller, DHSc, MPH, CIC David Almeida, MD, PhD Eduardo

Demographics-Age/Sex (N=50)Female = 54%Males = 46%

32

12

64

16

1210

8

05

1015

2025

3035

<= 20 yrs 21-40 yrs 31-60 yr >60 yrs

%

females males

Page 9: Persistence and Prevalence of MRSA on Ocular Surface following Primary MSSA/MRSA Infections Darlene Miller, DHSc, MPH, CIC David Almeida, MD, PhD Eduardo

Clinical Diagnosis-Persistent MRSA Colonizers (N=50)

4

8

12

24

52

0 10 20 30 40 50 60

endophthalmitis

keratoconjunctivitis

dacryocystitis

keratitis

conjunctivitis

%

Presenting diagnosis

Page 10: Persistence and Prevalence of MRSA on Ocular Surface following Primary MSSA/MRSA Infections Darlene Miller, DHSc, MPH, CIC David Almeida, MD, PhD Eduardo

Change in Vancomycin MIC Among Repeat MRSA Isolates

0

10

20

30

40

50

60

70

Increased 2X Increased 4X Decreased1/2X

No Change

% c

ha

ng

e

Vancomycin MIC

24% increase in vancomycin MIC, (100% susceptible)

Page 11: Persistence and Prevalence of MRSA on Ocular Surface following Primary MSSA/MRSA Infections Darlene Miller, DHSc, MPH, CIC David Almeida, MD, PhD Eduardo

SummaryMRSA rates increased from 8% at baseline

(1990-1994) to 38% in the last 4.5 years (2005-June 2009).

Persistent MRSA colonization remain stable over the 19 year period (7.7%).

Persistent MRSA was more frequently recovered from conjunctivitis and women >60 yrs.

24% of repeat MRSA isolates demonstrated increased Vancomycin MICs

Page 12: Persistence and Prevalence of MRSA on Ocular Surface following Primary MSSA/MRSA Infections Darlene Miller, DHSc, MPH, CIC David Almeida, MD, PhD Eduardo

Clinical RelevanceColonization or Persistent MRSA on the

ocular surface can serve as:

Reservoir/foci for post surgical infections.

Antigenic trigger for increased/chronic inflammation.

Repeat or persistent MRSA isolation may impact in vivo efficacy of vancomycin.