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Article
March 1997

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

Author Affiliations

From the Centers for Disease Control and Prevention, Hospital Infections Program (Drs Bannerman and Miller, Mr Rhoden, and Ms McAllister), and Emory Eye Center, Emory University School of Medicine (Dr Wilson), Atlanta, Ga. A complete listing of the members of the Endophthalmitis Vitrectomy Study Group was published previously (Arch Ophthalmol. 1995;113:1493-1495).

Arch Ophthalmol. 1997;115(3):357-361. doi:10.1001/archopht.1997.01100150359008
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.

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