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Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Methicillin-Resistant Staphylococcus aureus-Associated Diarrhea in a Critically Ill Burn Patient
Aldin Malkoc1,2, David T Wong2
1St. George's University School of Medicine, True Blue Rd, True Blue, Grenada.
Abstract:
Described in surgical patients after antibiotic use in the 1950s and 1960s, Staphylococcus aureus (S. aureus) enterocolitis is a rare form of nosocomial diarrhea. However, S. aureus is not routinely tested like Clostridium difficile (C. difficile). We report a case of methicillin-resistant S. aureus (MRSA) enterocolitis found on stool culture in a 22-week pregnant female with a previously negative nasal MRSA culture, and a total burn surface area greater than 60%. She also developed necrotizing MRSA pneumonia and bacteremia. After starting broad-spectrum antibiotic for the necrotizing pneumonia with subsequent acute respiratory distress syndrome, the patient exhibited large voluminous diarrhea that tested positive for MRSA and negative for C. difficile in the stool culture. Similar to other reports of high-volume diarrhea, the diarrhea resolved quickly with enteral vancomycin. S. aureus should be considered along with C. difficile during the workup of nosocomial diarrhea, especially with exposure to broad-spectrum antibiotics in the critically ill patient.
Insights
Staphylococcus aureus enterocolitis is a rare cause of hospital-acquired diarrhea. This case highlights the need to test for MRSA alongside C. difficile in critically ill patients receiving antibiotics.
Area of Science:
- Infectious Diseases
- Gastroenterology
Background:
- Staphylococcus aureus enterocolitis is a rare nosocomial diarrhea, historically observed in surgical patients post-antibiotic use.
- Unlike Clostridium difficile, Staphylococcus aureus is not routinely screened for in cases of infectious diarrhea.
Observation:
- A case of methicillin-resistant Staphylococcus aureus (MRSA) enterocolitis was diagnosed via stool culture in a severely burned, 22-week pregnant patient.
- The patient presented with necrotizing MRSA pneumonia, bacteremia, and acute respiratory distress syndrome, necessitating broad-spectrum antibiotics.
Findings:
- The patient developed voluminous diarrhea, positive for MRSA and negative for C. difficile.
- Treatment with enteral vancomycin led to rapid resolution of the MRSA-induced diarrhea.
Implications:
- Staphylococcus aureus should be considered in the differential diagnosis of nosocomial diarrhea, particularly in critically ill patients on broad-spectrum antibiotics.
- Diagnostic protocols for hospital-acquired diarrhea should include testing for S. aureus, similar to C. difficile.
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