Staphylococcal Blepharitis and Blepharokeratoconjunctivitis in Southeast Asia: Microbiological Profile and Antibiotic Sensitivity Patterns

Purpose To describe the clinical and microbiological profile of patients with staphylococcal blepharitis and blepharokeratoconjunctivitis (BKC) in a Philippine tertiary hospital, determine antibiotic susceptibility patterns, and evaluate associations between bacterial species, resistance profiles, and disease severity. Methods This single-center prospective observational study included 30 patients (60 eyes) clinically diagnosed with staphylococcal blepharitis or BKC. Detailed clinical history, slit-lamp examination, and visual acuity measurements were documented. Eyelid margin swabs were obtained for organism identification and antibiotic susceptibility testing. Associations between microbiologic data and clinical presentation were analyzed using Kruskal–Wallis, Mann–Whitney U, and Spearman correlation tests. Results Twenty-seven patients (90%) yielded positive cultures and 34 staphylococcal isolates were identified. All isolates were Staphylococcus species, most commonly Staphylococcus epidermidis (47.1%), over half of which were methicillin-resistant. No methicillin-resistant Staphylococcus aureus was detected. High resistance rates were observed for penicillin and erythromycin, while fluoroquinolones and aminoglycosides demonstrated excellent antimicrobial sensitivity. No significant associations were found between bacterial species, antibiotic resistance patterns, and clinical presentation. Corneal involvement was found to have significantly worse visual acuity and a higher symptom burden positively correlated with more clinical signs. Conclusion Staphylococcal species and antibiotic resistance patterns did not correlate with disease severity or clinical presentation. Disease severity appears to be more strongly driven by bacterial toxin production, delayed consultation, and host susceptibility. Aminoglycosides remain highly effective for treatment. Although methicillin-resistant Staphylococcus epidermidis was common, it did not confer worse clinical outcomes.