MRSA enteritis causing a high stoma output in the early postoperative phase after bowel surgery

Nosocomial MRSA infection has become an important healthcare issue. We present 6 cases of MRSA enteritis, acquired following bowel surgery and ileostomy formation.

The data set was obtained from the experience of one consultant surgeon over 6 years in one medical centre. The clinical features and course of six patients that developed MRSA enteritis postoperatively were obtained through review of case notes and laboratory data.

Four male and two female patients (age range, 22-80 years) developed a clinical syndrome postoperatively requiring treatment within the high dependency unit. Three developed respiratory distress syndrome, and one died from multi-organ failure. Exploratory laparotomy carried out in three patients was negative. All patients were MRSA-negative on admission but had swabs positive for MRSA from ileostomy site postoperatively. All of the three patients who had ileostomy effluent cultured for MRSA had positive results.

Fever, abdominal pain, distension and high stoma output in the early postoperative period following bowel surgery should alert the clinician to the possibility of MRSA enteritis. Patients require aggressive resuscitation and culture of ileostomy effluent for MRSA. Exploratory laparotomy has no obvious benefits. As MRSA enteritis has the potential to be a lethally effective disseminator of MRSA, such clinical features should prompt early instigation of appropriate infection control practices.