Watch for Patients With MRSA or MRSE

Eyenet

It is no longer just health care workers whom ophthalmologists should view as at risk for postoperative infection by antibiotic-resistant bacteria, according to a study of cataract surgery patients at 10 sites across the United States.Approximately half of the 399 patients in the study had preoperative lid or conjunctival presence of methicillinresistant forms of Staphylococcus epidermidis (MRSE) or S. aureus (MRSA).1 These are the most common pathogens causing endophthalmitis (S. epidermidis) after phacoemulsification and bacterial keratitis (S. aureus) after refractive surgery.........
Dr. Donnenfeld said that at the eye surgery center where he is medical director the anti-MRSE/MRSA protocols include:

Minimizing infection risk by treating even mild blepharitis before refractive surgery. He recommends a week of hot compresses, eyelid cleansing (SteriLid) and azithromycin 1 percent (Aza- Site) drops applied to the ocular surface and also rubbed into the lid margins, twice daily.
Beginning a fourth-generation fluoroquinolone on the day of LASIK rather than at the time of surgery. He continues the antibiotic for five days postoperatively.
Dosing with the antibiotic for three days before cataract surgery and 10 days after.
Using intracameral vancomycin during cataract surgeries.