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E.M. Happ, R.P. Kowalski, F.S. Mah; Can MRSA (Methicillin Resistant Staphylococcus aureus) Keratitis Be Successfully Treated? . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2624.
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Purpose: The purpose of this study is to compare the clinical outcomes of infectious keratitis by methicillin resistant Staphylococcus aureus (MRSA) to methicillin sensitive Staphlococcus aureas (MSSA) and to report the susceptibility of these pathogens to potential therapeutic options. Methods: A retrospective analysis of the seven year period starting August 1996 and ending August 2003 of all keratitis patients culture positive for Staphylococcus aureus (20 cases of MRSA; 14 cases of MSSA) from our clinic was completed. Age and gender were compared. Resolution of infectious keratitis was calculated by time to re–epithelization, and time to infiltrate resolution. Susceptibilities of the Staphylococcus aureus isolates to various antibiotics was completed. Results:All 34 keratitis cases resolved without adverse events. There were no statistical differences in age or gender. The time range for re–epithelization for MRSA infections was 1–88 days, and 3–55 days for MSSA keratitis. The median/mean time for infiltrate resolution for MRSA was 19/39 days and 19/27 days for MSSA. There were no statistical differences between MRSA and MSSA (p>0.05). Comparing MICs for MRSA isolates, moxifloxacin had statistically significant lower MICs than the other currently available topical fluoroquinolones (p=0.00001). Among all antimicrobial agents, vancomycin, bacitracin and cefazolin had the best coverage of Staph aureus keratitis isolates in terms of percent susceptibility. Conclusions: Methicillin–resistant Staphylococcus aureus (MRSA) causing acute bacterial keratitis can be successfully eradicated. Clinical response along with in vitro antibiotic susceptibility testing should be used as guides in the management of infectious keratitis until the ophthalmic community can determine better predictors for the successful treatment of bacterial keratits.
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