PURPOSE: To characterize the patient demographics, clinical features, and 
antibiotic susceptibility of ocular infections caused by methicillin-resistant 
Staphylococcus aureus (MRSA), including community-associated (CA) and 
healthcare-associated (HA) isolates.
DESIGN: Retrospective, observational study.
PARTICIPANTS: Patients (n = 519) with culture-proven S. aureus ocular infections 
seen between January 1, 1999, and December 31, 2008, in Chang Gung Memorial 
Hospital.
METHODS: Data collected included patient demographics and clinical information. 
Antibiotic susceptibility was verified by disc diffusion method.
MAIN OUTCOME MEASURES: Proportion of MRSA in S. aureus ocular infections and the 
clinical characteristics, diagnoses, and antibiotic susceptibility patterns of 
CA-MRSA versus HA-MRSA ocular infections.
RESULTS: We identified 274 patients with MRSA ocular infections, which comprised 
181 CA-MRSA and 93 HA-MRSA isolates. The average rate of MRSA in S. aureus 
infections was 52.8% with a stable trend, whereas the annual ratio of CA-MRSA in 
ocular MRSA infections averaged 66.1% and tended to increase over the 10-year 
interval. Patients with ocular CA-MRSA were younger. Lid and lacrimal system 
disorders were more common, but keratitis, endophthalmitis, and wound infection 
were less common among CA-MRSA cases than HA-MRSA cases. Both CA-MRSA and 
HA-MRSA isolates were resistant to clindamycin and erythromycin, but CA-MRSA was 
more susceptible to sulfamethoxazole/trimethoprim.
CONCLUSIONS: Community-associated MRSA is an important pathogen of ocular 
infections; CA-MRSA and HA-MRSA ocular infections differ demographically and 
clinically, but both strains were multi-resistant in Chang Gung Memorial 
Hospital, one of the biggest referral centers in Taiwan. In a country with a 
high prevalence of MRSA, ophthalmologists should be aware of such epidemiologic 
information.