Molecular and Phenotypic Characterization of <i>Staphylococcus epidermidis</i> Isolates from Healthy Conjunctiva and a Comparative Analysis with Isolates from Ocular Infection

<div><p><i>Staphylococcus epidermidis</i> is a common commensal of healthy conjunctiva and it can cause endophthalmitis, however its presence in conjunctivitis, keratitis and blepharitis is unknown. Molecular genotyping of <i>S</i>. <i>epidermidis</i> from healthy conjunctiva could provide information about the origin of the strains that infect the eye. In this paper two collections of <i>S</i>. <i>epidermidis</i> were used: one from ocular infection (n = 62), and another from healthy conjunctiva (n = 45). All isolates were genotyped by pulsed field gel electrophoresis (PFGE), multilocus sequence typing (MLST), staphylococcal cassette chromosome <i>mec</i> (SCC<i>mec</i>), detection of the genes <i>icaA</i>, <i>icaD</i>, IS256 and polymorphism type of <i>agr</i> locus. The phenotypic data included biofilm production and antibiotic resistance. The results displayed 61 PFGE types from 107 isolates and they were highly discriminatory. MLST analysis generated a total of 25 STs, of which 11 STs were distributed among the ocular infection isolates and lineage ST2 was the most frequent (48.4%), while 14 STs were present in the healthy conjunctiva isolates and lineage ST5 was the most abundant (24.4%). By means of a principal coordinates analysis (PCoA) and a discriminant analysis (DA) it was found that ocular infection isolates had as discriminant markers <i>agr</i> III or <i>agr</i> II, SCC<i>mec</i> V or SCC<i>mec</i> I, <i>mecA</i> gene, resistance to tobramycin, positive biofilm, and IS256⁺. In contrast to the healthy conjunctiva isolates, the discriminating markers were <i>agr</i> I, and resistance to chloramphenicol, ciprofloxacin, gatifloxacin and oxacillin. The discriminant biomarkers of ocular infection were examined in healthy conjunctiva isolates, and it was found that 3 healthy conjunctiva isolates [two with ST2 and another with ST9] (3/45, 6.66%) had similar genotypic and phenotypic characteristics to ocular infection isolates, therefore a small population from healthy conjunctiva could cause an ocular infection. These data suggest that the healthy conjunctiva isolates do not, in almost all cases, infect the eye due to their large genotypic and phenotypic difference with the ocular infection isolates.</p>