Abstract
Background: Most nosocomial antibiotic-associated diarrhea cases associated with MRSA reported are from Japan, and this entity is rarely documented in North America. We report five cases of nosocomial antibiotic-associated diarrhea caused by MRSA at a Veterans Affairs (VA) Medical Center in North Dakota, USA. Methods: We conducted a chart review and data analysis of five hospitalized patients with MRSA-associated diarrhea from March 2002 to January 2008. We abstracted the data from electronic medical records and laboratory reports. Results: The stools of all five patients were watery with a heavy growth or pure culture of MRSA. The stools all tested negative for Clostridium difficile toxin A/B, enteric bacterial pathogens, or ova/parasites. Four patients’ diarrhea resolved rapidly after starting oral vancomycin. One patient's (case 1) diarrhea subsided slowly without taking oral vancomycin. All patients were discharged home following subsidence of the MRSA-associated diarrhea. Characteristics of the five cases of MRSA-associated diarrhea are shown in the following table. Conclusion: Should a hospitalized patient exposed to antibiotics develop watery, green stools, suspicion of MRSA-associated diarrhea should be high and stool sent for culture to rule out MRSA. Even before the stool culture results are known, we suggest starting oral vancomycin empirically if diarrhea is severe or life threatening.
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