Nasal and conjunctival screening prior to refractive surgery: an observational and cross-sectional study

• Published in: BMJ open Vol. 6; no. 5; p. e010733
• Main Authors: Kitazawa, Koji, Sotozono, Chie, Sakamoto, Masako, Sasaki, Miho, Hieda, Osamu, Yamasaki, Toshihide, Kinoshita, Shigeru
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 09.05.2016; BMJ Publishing Group
• Subjects: Ablation; Adult; Antibiotics; Asthma; Bacteria; Carrier State - diagnosis; Carrier State - microbiology; Conjunctiva - microbiology; Contact lenses; Corynebacterium - isolation & purification; Cross-Sectional Studies; Dermatitis; Dermatitis, Atopic - complications; Eye surgery; Female; Gram-positive bacteria; Health Personnel; Humans; Japan; Male; Medical personnel; Methicillin-Resistant Staphylococcus aureus - drug effects; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Nasal Cavity - microbiology; Ophthalmology; Patients; Preoperative Care; Propionibacterium acnes - isolation & purification; Questionnaires; Refractive Surgical Procedures - methods; Risk Factors; Staphylococcus epidermidis - isolation & purification; Staphylococcus infections; Statistical analysis; Streptococcus infections; Japan; refractive surgery; nasal colonization; LASIK; infectious keratitis; MRSA
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2015-010733

ObjectivesTo investigate bacterial flora of clinically healthy conjunctiva and nasal cavity among patients prior to refractive surgery, as well as the characteristics of patients with methicillin-resistant Staphylococcus aureus (MRSA) colonisation.DesignObservational and cross-sectional study.SettingA single-centre study in Japan.Participants120 consecutive patients pre-refractive surgery.Primary and secondary outcome measures methodsSamples were obtained from the right conjunctival sac and the nasal cavity of 120 consecutive patients prior to refractive surgery and were then measured for the levels of the minimum inhibitory concentration (MIC) of antibiotics. Patients were interviewed regarding their occupation, family living situation and any personal history of atopic dermatitis, asthma, smoking or contact lens wear.ResultsPropionibacterium acnes (P. acnes) (32.5%) and Staphylococcus epidermidis (4.2%) were detected from the conjunctival sac. S. epidermidis was the most commonly isolated (68.3%) in the nasal cavity. Of the 30 patients (25.0%) with colonisation by S. aureus, 2 patients, both of whom were healthcare workers with atopic dermatitis, were found to be positive for MRSA in the nasal cavity. A history of contact lens wear, asthma or smoking, as well as patient gender and age, was not associated with MRSA colonisation.ConclusionsThere were only 2 patients who were colonised with MRSA, both of whom were healthcare workers with atopic dermatitis. P. acnes was predominantly found in the conjunctival sac. Further study is needed to investigate the involvement between nasal and conjunctival flora, and risk factors for infectious complications.