Eyeworld

EW NEWS & OPINION 21 that it would be interesting to evalu- ate how bacteria in the eye vary across the country," Dr. Olson said. "We also wanted to investigate this because we think of MRSA as being largely a problem of healthcare workers, and we wanted to know if that is still the case today." Included in this prospective, multicenter, case series were 399 consecutive, uncomplicated cataract patients. For the study, investigators took a sample from the non-opera- tive eye to see exactly what bacterial colonization looked like. Patients were given a questionnaire to deter- mine their background as well as systemic diseases that they might have. Nearly ubiquitous MRSA The findings pegged MRSA as pro- lific. "We determined that MRSA is very common, and in some parts of the world it affects the majority of patients," Dr. Olson said. He found that Salt Lake City was one such place. "Over 60% of our patients who walk in the door for cataract surgery are going to have MRSA and/or MRSE [methicillin-resistant Staphylococcus epidermidis] in their eyes," Dr. Olson said. "Some people are talking about different solutions such as leaving your MRSA patients until the end of the day, but the odds are that the majority of pa- tients are going to have MRSA, so we have to face the fact that most of the time we're going to have patients who have superbugs on the surface of their eyes." In this multicenter study, inves- tigators surprisingly found that the highest methicillin resistance was in the Salt Lake City area and in Texas. "That was interesting because both areas have relatively broad agricul- tural communities, and there is the perception that superbugs are be- coming more influenced by agribusi- ness than by healthcare," Dr. Olson said. "We found that there's no cor- relation [to healthcare] anymore— you're actually more likely to have MRSA if you're not a healthcare worker than if you are." Another finding that Dr. Olson sees as particularly interesting is the fact that older patients are more likely to be affected by MRSA. "This is an age-correlated phenomenon," he said. "The older you are, the more likely it is that you've been treated with antibiotics." Clinical perspective Even areas of the country that were not linked to agribusiness had rela- tively high MRSA rates. Dr. Olson sees this as having significant clini- cal implications. "Right now, physi- cians should expect that no matter where they are in the U.S., no less than one-third of their patients al- ready have MRSA," he said. "In our area we're at 60%, so we realize that the majority of the time, we're going to be dealing with multi-drug resist- ance, and the older the patient, the greater the likelihood that we're going to have bad bacteria to deal with." Dr. Olson finds this concerning. "So far treatment with vancomycin has had good results, but more and more we're seeing Staph that is not only multi-fluoroquinolone-resis- tant, but also vancomycin-resistant," he said. "This raises the question: What do we have available to treat these patients? The answer is that there are fewer and fewer options." The future This could make for a scary future for ophthalmologists. Dr. Olson pre- dicts that as ophthalmologists look at Staph epidermidis and Staph aureus, they are going to find that the ma- jority is resistant to fourth-genera- tion fluoroquinolones. In a future study, he hopes to look more closely at healthcare workers in particular to see specifically what MRSA looks like for such patients. Overall, Dr. Olson sees the re- sults of the recent study as commen- tary on where bacterial management now stands. "If there's one key les- son here, it's that in the never-end- ing battle between single-organism bacteria and humans, who are sup- posedly at the apex of things, it's the bacteria that are now winning," he said. "We've got to get smarter be- cause new antibiotics are not pop- ping up very fast, and we're getting pretty thin on what we have avail- able for these bad Staph. The super- bug Staph is primarily what we're going to find on the conjunctiva of our elderly patients in many areas of the country." EW Editors' note: Dr. Olson had a financial interest with Allergan (Irvine, Calif.) in 2010. Contact information Olson: 801-581-2352, randallj.olson@hsc.utah.edu RHEIN CODE RHEIN CODE DRYEYE CODE DRYEYE CODE ABBB 1316 Rev.B D U R I N G P R O B I N G A F T E R P R O B I N G D U R I N G G P R O B I N D U R I N A F T E G R P R O B I N A F T E RHEIN CODE RHEIN CODE .B v 1316 Re ABBB YEYE CODE DRYEYE CODE YEYE CODE DRYEYE CODE May 2011

• Cover