Enteral vancomycin and probiotic use for methicillin-resistant Staphylococcus aureus antibiotic-associated diarrhoea

Area of Science:

• Infectious Diseases
• Microbiology
• Geriatric Medicine

Background:

• Persistent intestinal and nasal methicillin-resistant Staphylococcus aureus (MRSA) colonization can be challenging to treat, especially in post-surgical geriatric patients.
• Multiple antibiotic courses failed to resolve MRSA infection in this patient, highlighting the need for alternative therapeutic strategies.

Observation:

• A geriatric patient with a history of intraabdominal surgery presented with persistent diarrhea and heavy intestinal MRSA growth.
• Anterior nares cultures also tested positive for MRSA, indicating a potential reservoir for persistent infection.

Findings:

• A 10-day course of oral vancomycin, a 15-day course of Saccharomyces boulardii (probiotic), and a 5-day course of topical mupirocin resulted in the cessation of diarrhea.
• Follow-up cultures demonstrated complete eradication of MRSA from stool and negative MRSA growth in the nares 11 days after therapy initiation.
• Sustained negative MRSA growth in stool and minimal nasal MRSA growth were observed 5 months post-treatment, indicating successful eradication and containment.

Implications:

• Enteral vancomycin combined with probiotics offers a potential treatment for refractory MRSA gastrointestinal infections.
• This therapeutic approach may prevent recurrence and complications associated with MRSA colonization in vulnerable patient populations.
• Further research is warranted to validate the efficacy and safety of this controversial treatment regimen.