Methicillin-resistant Staphylococcus Aureus Enteritis Research Articles

Analysis on risk factors of methicillin-resistant staphylococcus aureus enterocolitis after gastrointestinal surgery

To investigate the risk factors of methicillin-resistant Staphylococcus aureus(MRSA) enterocolitis after gastrointestinal surgery. Clinical and pathological data of 17 cases with MRSA enteritis after gastrointestinal surgery from March 2015 to March 2017 at Department of General Surgery of Affiliated Drum Tower Hospital were retrospectively analyzed. (1) age of 18 to 80 years;(2) with history of gastrointestinal surgery; (3) diarrhea symptoms within 7 days after gastrointestinal surgery; (4) use of antibiotics before diarrhea; (5) fecal smear showing a large number of gram positive cocci; (6) fecal culture suggested the presence of MRSA; (7) application of antibiotic therapy against MRSA was effective. (1)clostridium difficile toxin positive; (2) toxic shock syndrome caused by food poisoning. According to gender, age, and inpatient ward, 1:2 pairing was performed, and 34 patients with non-MRSA enteritis from the hospitalized cases in the same ward were selected as the control group for retrospective case-control study. There were no significant differences in the gender, age, and constitution index between two groups (all P>0.05), indicating that the two groups were comparable. The χ² test was used to perform univariate analysis on 11 factors, including the nature of the primary disease, colorectal surgery, emergency surgery, use of multiple antibiotics, preoperative bowel preparation, perioperative hormone, intraoperative intraperitoneal chemotherapy, perioperative nasogastric tube, diabetes history, intensive care unit stay, and previous infectious disease hospitalization, and then multivariate logistic regression analysis was performed. MRSA enteritis occurred 3 to 5 days after surgery in all the 17 cases, and 4 cases developed septic shock rapidly. Univariate analysis showed that the operation site (colorectal surgery) (χ²=4.747, P=0.029) and use of two antibiotics before MRSA enteritis (χ²=3.959, P=0.047) were associated with MRSA enteritis after gastrointestinal surgery. Multivariate logistic regression analysis revealed that colorectal surgery was the only independent risk factor for MRSA enteritis after gastrointestinal surgery(OR=5.526, 95%CI: 1.350-22.602,P=0.017), while the use of two antibiotics was not (OR=0.204, 95%CI:0.051-0.819, P=0.025). MRSA enteritis has a rapid onset, and a high incidence of septic shock, which requires immediate attention. Colorectal surgery is an independent risk factor for MRSA enteritis.

Nasal MRSA screening for surgical patients: predictive value for postoperative infections caused by MRSA

Postoperative methicillin-resistant Staphylococcus aureus (MRSA) infections are occasionally fatal. We hypothesized that nasal MRSA screening might predict the risk of postoperative MRSA infections. The aim of the current study was to elucidate the relationship between the positivity of nasal MRSA screening and postoperative MRSA infections. Six hundred and fourteen surgical patients who were admitted to the intensive care unit and underwent nasal MRSA screening between April 2006 and March 2011 were divided into MRSA-positive and -negative groups. The incidence of postoperative MRSA infections in the MRSA-positive and MRSA-negative groups were compared, and various risk factors for MRSA infections were evaluated. The incidence of postoperative MRSA infections, such as pneumonia and enteritis, in the MRSA-positive group was significantly higher than that in the MRSA-negative group (41.9 vs. 3.1 %). The significant independent risk factors for postoperative MRSA infections were a positive MRSA screening, an operation lasting more than 300 min and an emergency operation. A positive MRSA screening was the most statistically significant risk factor for postoperative MRSA pneumonia and enteritis, but was not a risk factor for MRSA surgical site infections. Nasal MRSA screening can help to identify patients who have an increased risk of developing postoperative MRSA infections, and would enable physicians to take a prompt action if these complications occur.

MRSA Enteritis

Purpose: Case:An 83 year old retired dentist presented to the Emergency Room from a nursing facility with a 3 day history of left lower quadrant abdominal crampy non-radiating pain, anorexia and diarrhea. He was hospitalized for a hip fracture complicated by a pneumonia three weeks prior to the presentation. His past medical history was significant for Diabetes Mellitus, Atrial fibrillation, Hypertension and Gout. The patient was on Lipitor, Propranolol, Insulin, Warfarin and Colchicine. On exam, patient was an ill appearing elderly male who was afebrile but tachycardic with an irregular rhythm. The abdominal exam revealed moderate tenderness to palpation in the left lower quadrant without signs of peritonitis. On laboratory data was a leucocytosis of 22,000/ul, a creatinine of 1.3 mg/ml, an INR of 5.7 and urinalysis revealed 8-10 Leucocytes. A CT scan of the abdomen with intravenous contrast was obtained to rule out diverticulitis, which showed a long segment of circumferential mural thickening involving the distal duodenum and proximal jejunum with adjacent stranding. The patient was started on intravenous Metronidazole and Levofloxacin without any improvement by day 4. It was decided to perform an enteroscopy and a colonoscopy as soon as the INR level was acceptable. On day 5, stool cultures grew large numbers of Methicillin Resistant Staphylococcus aureus (MRSA). The patient was started on Vancomycin with complete resolution of pain and diarrhea by day 7 of hospitalization. Discussion: Humans are a natural reservoir of SA. 30-50% of healthy adults are colonized intermittently with the organism. The respiratory tract is the major harbor being involved in up to 15-44% of cases. 5.3% of the patients who are admitted for surgeries and 9% of health care workers have been found to carry MRSA. MRSA enteritis is a very unusual cause of diarrhea which has not been widely studied. Patients present with fever, profuse watery diarrhea and evidence of systemic inflammatory response which may progress to multi-organ failure. The diarrhea typically presents 2-3 days post-operatively and lasts for 5 or more days. Recent surgical operation, antibiotic and/or gastric acid suppressing drugs are usually associated with its occurrence. Post-operative MRSA enteritis can be fatal unless treated with antimicrobial therapy. A Japanese multicentric study assessed the efficacy and safety of Vancomycin in the treatment of MRSA enteritis. 49 patients with diagnosed or strongly suspected MRSA enteritis were given Vancomycin 500 mg four times a day with a 100% clinical response rate. Lately there has been a considerable interest in the specific phenotypic and genotypic characteristic of the organisms causing MRSA enteritis.

Clinical studies of enteritis caused by methicillin-resistant Staphylococcus aureus.

To study the clinical features of methicillin-resistant Staphylococcus aureus (MRSA) enteritis in our surgical ward. Retrospective study. Teaching hospital, Japan. 16 men and 1 woman who developed MRSA enteritis from January 1995 to October 1999. Causes and treatments. The underlying diseases were as follows: gastric cancer (n = 13), colorectal cancer (n = 2), recurrent cancer (n = 1) and bowel obstruction following gastrectomy (n = 1). 16 patients were operated on. Two cases were treated with histamine H2 receptor blockers. The mean age of patients was 65 years (range 50-80). In 13 cases MRSA enteritis developed within 6 days of operation. 10 strains of MRSA were isolated from stools, 8 from gastric juice, and 3 from intra-abdominal exudate. 10 patients were treated with vancomycin given through a nasogastric tube and 2 through a nasogastric tube and by drip intravenous infusion. 15 patients survived and 2 died. Patients who are given broad-spectrum antibiotics and whose gastric secretion is reduced are at high risk of MRSA enteritis. In the surgical ward, early diagnosis, treatment, and isolation are essential for patients with MRSA enteritis.

Multiple intestinal ulcerations and perforations secondary to methicillin-resistant Staphylococcus aureus enteritis in infants

Purpose: The aim of this study was to define a distinctive clinical entity of multiple intestinal ulcerations and perforations in infants. Methods: Two infants underwent abdominal exploration for surgical abdomen and were noted to have multiple intestinal ulcerations and perforations. A peculiar and unique surgical finding, numerous transverse linear ulcerations scattered along the entire small intestine, prompted us to search for similar instances. Five similar cases were additionally identified by members of the Korean Association of Pediatric Surgeons. The clinical courses, the surgical findings, and the results of bacterial cultures were reviewed. As well, the tissues of resected intestines were examined histopathologically. Results: The characteristics of this entity are as follows. (1) It usually occurs in infants who have been treated with broadspectrum antibiotics. (2) Despite broad-spectrum antibiotic treatment, diarrhea and abdominal distension developed progressively and deteriorated. (3) Histological evaluation showed mucosal ulcers with neutrophil infiltration, submucosal microabscesses, and colonies of Gram-positive cocci. (4) Methicillin-resistant Staphylococcus aureus (MRSA) was the predominant organism cultured from the body fluid. (5) Only two cases, the completely resected one and the one immediately treated postoperatively with vancomycin, survived. Conclusions: This entity is caused by multiple intestinal ulcerations and perforations secondary to MRSA enteritis in infants. It has a high mortality rate because of its difficult diagnosis. However, early recognition of this entity can lead to successful treatment.

Postoperative enteritis caused by methicillin-resistant Staphylococcus aureus.

We examined the clinical features of 14 men (mean age 72 years) with postoperative enteritis caused by methicillin-resistant Staphylococcus aureus (MRSA). The patients had all undergone surgery for the treatment of digestive diseases and had received antibiotic prophylaxis consisting of an extended-spectrum cephem. Diarrhea appeared a mean of 3.3 days postoperatively and lasted for 5 days on average. In severe cases organ insufficiency was involved. Coagulate-positive staphylococci were the predominant organisms isolated from watery diarrhea. In 13 of 14 patients, coagulase type II isolates producing enterotoxins A, C and toxic shock syndrome toxin-1 (TSST-1) with enterotoxin A, C, and 1st genes were isolated. These strains were sensitive to vancomycin and arbekacin; however, they were highly resistant to many other antibiotics. We also investigated the effects of a glucocorticoid hormone and gamma globulin on production of tumor necrosis factor-alpha (TNF-alpha) and interleukin-2 (IL-2) obtained from healthy volunteers. TNF-alpha and IL-2 production was enhanced by TSST-1 and the supernatant of Iscove-modified dulbecco medium, in which coagulase type II isolates producing enterotoxins A, C and TSST-1 with enterotoxin A, C were cultured for 24 h. Both glucocorticoid hormone and gamma globulin suppressed TNF-alpha and IL-2 production, thus suggesting that these drugs may be effective in treating postoperative MRSA enteritis.

INVESTIGATION ON ENTERITIS CAUSED BY METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA)

Twenty-four cases of postoperative enteritis caused by methicillin-resistant Staphylococcus aureus (MRSA) experienced at the department in a past 5-year period were classified by times of clinical manifestation, and the course and mechanisms of the onset of this disease were investigated. There were 16 cases of early onset which manifested clinically within 6 days after the operation and 8 cases of delayed onset after the 7th postoperative day. Moderate and severe cases represented 75.0% of all early onset cases, and peripheral leukopenia was noted in 62.5% of them. These figures were greater than 25.9% and 12.5% in delayed onset cases, respectively. This might be arisen from a fact that in the early onset cases bowel movement was not recovered after the operation and MRSA-caused toxin remained in the intestine to be absorbed into the blood stream. Delayed onset cases were characterized by long-lasting fasting (11.8±3.1 days) and prolonged administration of antibiotics (13.9±8.2 days). These conditions were liable to cause alteration in intestinal bacterial normal flora to lead to bacterial alteration phenomenon to MRSA, but toxemia was hardly induced because of normal bowel movement. For this, mild case's dominance was observed in the delayed onset cases. It is considered that the delayed onset cases have a similar mechanism of occurrence to that of MRSA enteritis in the internal medicine, and hence early onset cases may actually have features characteristic of postoperative enteritis.

A study on postoperative enteritis caused by methicillin-resistant Staphylococcus aureus.

We investigated the production of staphylococcal enterotoxin (SE) with respect to coagulase types by methicillin-resistant Staphylococcus aureus (MRSA). A total of 138 strains of MRSA, which were isolated from clinical materials in the surgical ward between 1983 and 1990, were studied. Coagulase type IV strains produced SE A only, whereas coagulase type II strains were classified into four groups by SE production: SE B producing strains (32.7%), SE C producing strains (29.8%), SE B and C coproducing strains (12.5%), and SE A and C coproducing strains (25.0%). Almost all of the organisms (nine of ten) which were isolated from the feces of patients with MRSA enteritis were SE A and C coproducing strains. The coincidence in time of the prevalence of MRSA enteritis and the isolation SE A and C coproducing strains also demonstrated that these strains caused MRSA enteritis. Although SE C producing strains and SE A and C coproducing strains were simultaneously prevalent in 1990, the former tended to be sensitive while the latter tended to be resistant to minocycline. Considering the variety of antibiotic sensitivity in coagulase type II strains, it is thus considered to be of critical importance for epidemiologic purposes to further characterize isolates by SE typing.

CLINICAL STUDIES OF POSTOPERATIVE MRSA INFECTIOUS DISEASE

Clinical and bacteriological studies were performed on 45 cases of methicillin-resistant staphylococcus aureus (MRSA) infectious disease occurring after digestive system surgery encountered in the past nine months. To specifically identify the course and time of infection, sanitary conditions of the hospital and staffs were bacteriologically examined, as were patients' preoperative and postoperative throat cultures. Postoperative MRSA enterocolitis frequently occurred early on. Early diagnosis is crucial, and oral administration of vancomycin (VCM) and opium tincture were effective. MRSA was also detected in the hospital, in the throat cultures, and on the fingers of hospital staffs MRSA from most of the staffs were coagulase type II, as were from the patients. However, the minimum inhibitory concentration (MIC) of MRSA determined in staffs throat cultures differed from that in patient throat cultures. Although MRSA enterocolitis occurred in 15 of 51 surgical cases, no MRSA was detected from them pre- or intra-operatively. Postoperative insertion of a feeding tube did not increase the incidence of enterocolitis. It is thus likely that the MRSA infectious disease encountered at this hospital was a nosocomial infection, epidemic strain type II, and was postoperatively transmitted primarily from the fingers of the medical staffs. Thorough countermeasures to cope with nosocomial infection are likely necessary to prevent postoperative MRSA enteritis.

Toxin involvement in methicillin-resistant Staphylococcus aureus enteritis in gastroenterological surgery

The authors investigated the production of toxic shock syndrome toxin-1 (TSST-1) and staphylococcal enterotoxins (SE) by Methicillin-resistant Staphylococcus aureus (MRSA) isolates to clarify the pathogenesis of postoperative MRSA enteritis in patients undergoing gastroenterological surgery. Regarding the percentage of TSST-1 producing strains, there was a significant difference between type II MRSA strains (68.8%) and type IV MRSA strains (4.2%). Among type II strains, all those producing staphylococcal entorotoxin (SE) type C (SEC) also produced TSST-1, although other strains that produced SEB without TSST-1 were commonly isolated. Strains producing SEA were potent producers of SE which was considered to be responsible for enteritis. Therefore, we hypothesized that the strains which produced both SEA and SEC tended to cause enteritis associated with TSS-like symptoms owing to the high titer of these toxins.