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The Source of Coagulase-Negative Staphylococci in the Endophthalmitis Vitrectomy Study: A Comparison of Eyelid and Intraocular Isolates Using Pulsed-Field Gel Electrophoresis

The Source of Coagulase-Negative Staphylococci in the Endophthalmitis Vitrectomy Study: A... Abstract Objective: To determine the species distribution of coagulase-negative staphylococci (CoNS) in patients with endophthalmitis and to ascertain whether the patient's own flora was a major source of postoperative endophthalmitis following cataract extraction. Methods: In a 4-year multicenter prospective study, 524 bacterial isolates were submitted from 225 Endophthalmitis Vitrectomy Study patients. From the 524 isolates, 250 represented CoNS cultured from the anterior chamber, the vitreous, or both of the 225 patients. Where possible, paired isolates from an individual patient's eyelid and intraocular compartment(s) were studied by pulsed-field gel electrophoresis, an established molecular straintyping technique. Results: From all sites the most frequently isolated CoNS were Staphylococcus epidermidis (81.9%) and Staphylococcus lugdunensis (5.9%). Where analysis was possible, eyelid isolates were indistinguishable from intraocular isolates in 71 (67.7%) of 105 comparisons. Non—S epidermidis CoNS caused postoperative endophthalmitis in 5 patients. Four of the 5 had postoperative endophthalmitis caused by S lugdunensis and 1 by Staphylococcus haemolyticus. Conclusions: Coagulase-negative staphylococci from the patient's periocular skin flora play a significant role in causing intraocular infections, and non—S epidermidis CoNS play a small but significant role. These results reinforce the necessity to follow stringent surgical site preparation prior to eye surgery. References 1. Bode DD Jr, Gelender H, Forster RK. A retrospective review of endophthalmitis due to coagulase-negative staphylococci . Br J Ophthalmol . 1985;69:915-919.Crossref 2. Driebe WT Jr, Mandelbaum S, Forster RK, Schwartz LK, Culbertson WW. Pseudophakic endophthalmitis: diagnosis and management . Ophthalmology . 1986;93:442-447.Crossref 3. Heaven CJ, Mann PJ, Boase DL. Endophthalmitis following extracapsular cataract surgery: a review of 32 cases . Br J Ophthalmol . 1992;76:419-423.Crossref 4. Shrader SK, Band JD, Lauter CB, Murphy P. The clinical spectrum of endophthalmitis: incidence, predisposing factors, and features influencing outcome . J Infect Dis . 1990;162:115-120.Crossref 5. Allen HF, Mangiaracine AB. Bacterial endophthalmitis after cataract extraction: a study of 22 infections in 20,000 operations . Arch Ophthalmol . 1964;72:454-462.Crossref 6. Speaker MG, Milch FA, Shah MK, Eisner W, Kreiswirth BN. Role of external bacterial flora in the pathogenesis of acute postoperative endophthalmitis . Ophthalmology . 1991;98:639-649.Crossref 7. Endophthalmitis Vitrectomy Study Group. Results of the Endophthalmitis Vitrectomy Study: a randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis . Arch Ophthalmol . 1995;113:1479-1496.Crossref 8. Kloos WE, Bannerman TL. Staphylococcus and Micrococcus . In: Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, eds. Manual of Clinical Microbiology . 6th ed. Washington, DC: American Society for Microbiology; 1995:282-298. 9. Kloos WE, Schleifer KH. Simplified scheme for routine identification of human Staphylococcus species . J Clin Microbiol . 1975;1:82-88. 10. Bannerman TL, Hancock GA, Tenover FC, Miller JM. Pulsed-field gel electrophoresis as a replacement for bacteriophage typing of Staphylococcus aureus . J Clin Microbiol . 1995;33:551-555. 11. Tenover FC, Arbeit RD, Goering RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing . J Clin Microbiol . 1995;33:2233-2239. 12. Gutierrez EH. Postoperative infections of the eye . In: Locatcher-khorazo D, Seegal BC, eds. Microbiology of the Eye . St Louis, Mo: CV Mosby Co; 1972:77-85. 13. Kleeman KT, Bannerman TL, Kloos WE. Species distribution of coagulase-negative staphylococcal isolates at a community hospital and implications for selection of staphylococcal identification procedures . J Clin Microbiol . 1993;31:1318-1321. 14. Maxwell DP Jr, Baber WB. Acute postoperative endophthalmitis associated with dual strains of Staphylococcus epidermidis . Ophthalmic Surg . 1992;23:222-224. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

The Source of Coagulase-Negative Staphylococci in the Endophthalmitis Vitrectomy Study: A Comparison of Eyelid and Intraocular Isolates Using Pulsed-Field Gel Electrophoresis

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References (14)

Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1997.01100150359008
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To determine the species distribution of coagulase-negative staphylococci (CoNS) in patients with endophthalmitis and to ascertain whether the patient's own flora was a major source of postoperative endophthalmitis following cataract extraction. Methods: In a 4-year multicenter prospective study, 524 bacterial isolates were submitted from 225 Endophthalmitis Vitrectomy Study patients. From the 524 isolates, 250 represented CoNS cultured from the anterior chamber, the vitreous, or both of the 225 patients. Where possible, paired isolates from an individual patient's eyelid and intraocular compartment(s) were studied by pulsed-field gel electrophoresis, an established molecular straintyping technique. Results: From all sites the most frequently isolated CoNS were Staphylococcus epidermidis (81.9%) and Staphylococcus lugdunensis (5.9%). Where analysis was possible, eyelid isolates were indistinguishable from intraocular isolates in 71 (67.7%) of 105 comparisons. Non—S epidermidis CoNS caused postoperative endophthalmitis in 5 patients. Four of the 5 had postoperative endophthalmitis caused by S lugdunensis and 1 by Staphylococcus haemolyticus. Conclusions: Coagulase-negative staphylococci from the patient's periocular skin flora play a significant role in causing intraocular infections, and non—S epidermidis CoNS play a small but significant role. These results reinforce the necessity to follow stringent surgical site preparation prior to eye surgery. References 1. Bode DD Jr, Gelender H, Forster RK. A retrospective review of endophthalmitis due to coagulase-negative staphylococci . Br J Ophthalmol . 1985;69:915-919.Crossref 2. Driebe WT Jr, Mandelbaum S, Forster RK, Schwartz LK, Culbertson WW. Pseudophakic endophthalmitis: diagnosis and management . Ophthalmology . 1986;93:442-447.Crossref 3. Heaven CJ, Mann PJ, Boase DL. Endophthalmitis following extracapsular cataract surgery: a review of 32 cases . Br J Ophthalmol . 1992;76:419-423.Crossref 4. Shrader SK, Band JD, Lauter CB, Murphy P. The clinical spectrum of endophthalmitis: incidence, predisposing factors, and features influencing outcome . J Infect Dis . 1990;162:115-120.Crossref 5. Allen HF, Mangiaracine AB. Bacterial endophthalmitis after cataract extraction: a study of 22 infections in 20,000 operations . Arch Ophthalmol . 1964;72:454-462.Crossref 6. Speaker MG, Milch FA, Shah MK, Eisner W, Kreiswirth BN. Role of external bacterial flora in the pathogenesis of acute postoperative endophthalmitis . Ophthalmology . 1991;98:639-649.Crossref 7. Endophthalmitis Vitrectomy Study Group. Results of the Endophthalmitis Vitrectomy Study: a randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis . Arch Ophthalmol . 1995;113:1479-1496.Crossref 8. Kloos WE, Bannerman TL. Staphylococcus and Micrococcus . In: Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, eds. Manual of Clinical Microbiology . 6th ed. Washington, DC: American Society for Microbiology; 1995:282-298. 9. Kloos WE, Schleifer KH. Simplified scheme for routine identification of human Staphylococcus species . J Clin Microbiol . 1975;1:82-88. 10. Bannerman TL, Hancock GA, Tenover FC, Miller JM. Pulsed-field gel electrophoresis as a replacement for bacteriophage typing of Staphylococcus aureus . J Clin Microbiol . 1995;33:551-555. 11. Tenover FC, Arbeit RD, Goering RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing . J Clin Microbiol . 1995;33:2233-2239. 12. Gutierrez EH. Postoperative infections of the eye . In: Locatcher-khorazo D, Seegal BC, eds. Microbiology of the Eye . St Louis, Mo: CV Mosby Co; 1972:77-85. 13. Kleeman KT, Bannerman TL, Kloos WE. Species distribution of coagulase-negative staphylococcal isolates at a community hospital and implications for selection of staphylococcal identification procedures . J Clin Microbiol . 1993;31:1318-1321. 14. Maxwell DP Jr, Baber WB. Acute postoperative endophthalmitis associated with dual strains of Staphylococcus epidermidis . Ophthalmic Surg . 1992;23:222-224.

Journal

Archives of Ophthalmology – American Medical Association

Published: Mar 1, 1997

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