To the Editor The recent case report by Clenenden et al.1 describes staphylococcal sepsis occurring in a female patient 8 days after shoulder arthroplasty. Postoperative analgesia was provided by continuous interscalene block for 5 days, with an earlier catheter that had dislodged being replaced after only 1 day. On the basis of the presence of a small hematoma at the site of the first catheter and growth of Staphylococcus aureus from a swab of the patient's neck, the authors concluded that the indwelling catheter was the cause of infection. However, we are not convinced that this is the true source of the infection. Staphylococcus aureus is present on the skin of 25% of the population. Catheter colonization is not uncommon but severe infections associated with continuous nerve blocks remain extremely rare.2,3 Furthermore, in the absence of any demonstrable abscess or significant cellulitis, it seems improbable that the rapid descent into profound septic shock originated from a catheter removed several days earlier. The facts suggest an alternative diagnosis, which, in our clinical opinion, is the more likely source. Staphylococcus aureus is a well-recognized cause of severe, even fatal, enterocolitis in adults. It is frequently, although not invariably, associated with prior antibiotic usage.4,5 Staphylococcal enterocolitis affecting the small bowel of previously healthy adults has been described, with acute patchy disease rapidly progressing to segmental gangrene.6 The authors state that segmental ischemic necrosis of the proximal jejunum was discovered on laparotomy, and that the peritoneal fluid was positive for Staphylococcus aureus. Although it may seem logical to ascribe a staphylococcal sepsis to a foreign body disrupting the skin barrier in this case, the overall clinical picture suggests otherwise. Clenenden et al.1 should consider, and rule out, alternative diagnoses before making such assumptions. In addition, we wish to once again highlight staphylococcal enterocolitis as an oft forgotten cause of nosocomial enterocolitis and sepsis.8 Rory Naughton, MB, MRCPI, FCARCSI Stephen Mannion, MB, FCARCSI Department of Anaesthesia and Intensive Care South Infirmary Victoria University Hospital Cork, Ireland [email protected]