PUBLICATION EXCLUSIVE: Are bacteria getting smarter?

For many of us premium surgeons, golf season has finally arrived, especially in regions such as the Midwest for me. On Memorial Day weekend, I embarked on my first rounds of the year after taking a fairly long sabbatical from lumbar fusion surgery 4 years ago and a broken fibula last September. The most frustrating part of that weekend was how horrible I played when at one time I was a 6 handicap golfer, but I was thankful to be playing again without injury nevertheless.As premium surgeons, we rarely experience that hopeless feeling of never wanting to touch a golf club again when perfect uncomplicated cataract surgery results in an unexpected intraocular infection in the immediate postoperative period for no apparent reason or known risk factors. The typical endophthalmitis pathogens of increasing prevalence are coagulase-negative staphylococci (CoNS) and methicillin-resistant Staphylococcus aureus (MRSA). Endophthalmitis rates vary from 0.028% to 0.3%, with the accepted U.S. rate approaching one in 1,000 to one in 1,500. Typical high-risk patients for developing MRSA infections after cataract surgery are prison inmates, military recruits, HIV-positive or other immunosuppressed patients (for example, diabetic patients), homeless persons, intravenous drug abusers, tattoo recipients, health care professionals (especially hospital-based), those with a known MRSA history, and those residing in nursing homes.