Related Experiment Videos
[Clinical spectrum of antibiotic associated enterocolitis due to methicillin resistant Staphylococcus aureus]
T Inamatsu1, H Ooshima, Y Masuda
1Tokyo Metropolitan Geriatric Hospital.
Abstract:
Historically, various types of antibiotic-associated diarrhea have been recognized. In the 1950-1960s, multi-resistant Staphylococcus aureus was implicated to be major cause of antibiotic-associated diarrhea, especially pseudomembranous enterocolitis. In the late 1970s, a new type of antibiotic-associated diarrhea, which is characterized by pseudomembranous colitis and lack of fecal multi-resistant S. aureus, usually following lincosamide administration, was recognized. Many studies have revealed the pathogenic roles of Clostridium difficile in these patients. Recent emergence of methicillin resistant S. aureus (MRSA) provokes another type of antibiotic-associated diarrhea. We have tried to isolate S. aureus and C. difficile from 150 faecal samples of patients with antibiotic-associated diarrhea. S. aureus alone was isolated from 32 (21.3%) samples. C. difficile alone was isolated from 51 (34.0%) samples, and, both were detected in 23 (15.3%) samples. 90.9% of S. aureus were MRSA. Comparing the clinical features of these cases, patients with both C. difficile and MRSA showed more serious clinical features. The patients who had undergone laparotomy were accompanied by shock and meteorism, more often than patients without laparotomy. The management of antibiotic-associated diarrhea due to MRSA is discussed.
Insights
Antibiotic-associated diarrhea can be caused by Clostridium difficile or methicillin-resistant Staphylococcus aureus (MRSA). Co-infection with both pathogens leads to more severe clinical features in patients.
Area of Science:
- Microbiology
- Infectious Diseases
- Gastroenterology
Background:
- Antibiotic-associated diarrhea (AAD) has evolved with changing microbial resistance patterns.
- Historically, Staphylococcus aureus and later Clostridium difficile were identified as key pathogens.
- The emergence of methicillin-resistant Staphylococcus aureus (MRSA) presents a new challenge in AAD.
Observation:
- This study analyzed 150 fecal samples from patients with AAD.
- Staphylococcus aureus was isolated from 21.3% and Clostridium difficile from 34.0% of samples.
- Both pathogens were detected concurrently in 15.3% of samples, with 90.9% of S. aureus isolates being MRSA.
Findings:
- Clostridium difficile was the most frequent single pathogen identified.
- Co-infection with C. difficile and MRSA was associated with more severe clinical presentations.
- Patients with a history of laparotomy experienced higher rates of shock and meteorism when co-infected.
Implications:
- Understanding the specific pathogens involved in AAD is crucial for effective management.
- The rise of MRSA necessitates tailored treatment strategies for AAD.
- Concurrent C. difficile and MRSA infections require aggressive clinical management due to severity.