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Background  An observational case series was used to study the virulence characteristics and genotypes of paired  Staphylococcus epidermidis  isolates cultured from intraocular samples and from periocular environment of patients with postcataract surgery endophthalmitis.    Methods  Eight  S. epidermidis  isolates were obtained from three patients (2 from patients #1 and 2 and 4 from patient #3) whose vitreous and/or anterior chamber (AC) specimens and preoperative lid/conjunctiva samples were culture positive. Cultures were identified by API-Staph phenotypic identification system and genotypically characterized by Fluorescent Amplified Fragment Length Polymorphism (FAFLP) and checked for their antimicrobial susceptibility. The isolates were tested for biofilm-production and methicillin-resistance (MR) by PCR amplification of  icaAB  and  mecA  gene respectively.    Results  Four out of eight  S. epidermidis  strains showed multiple drug resistance (MDR). All the eight strains were PCR positive for  mecA  gene whereas seven out of eight strains were positive for  icaAB  genes. In all three patients FAFLP typing established vitreous isolates of  S. epidermidis  strains to be indistinguishable from the strains isolated from the patient's conjunctival swabs. However, from patient number three there was one isolate (1030b from lid swab), which appeared to be nonpathogenic and ancestral having minor but significant differences from other three strains from the same patient. This strain also lacked  icaAB  gene.  In silico  analysis indicated possible evolution of other strains from this strain in the patient.    Conclusion  Methicillin-resistant biofilm positive  S. epidermidis  strains colonizing the conjunctiva and eyelid were responsible for postoperative endophthalmitis (POE).

bmc ophthalmology

Fluorescent amplified fragment length polymorphism (FAFLP) genotyping demonstrates the role of biofilm-producing methicillin-resistant periocular Staphylococcus epidermidis strains in postoperative endophthalmitis