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A Rare Case of Methicillin-Resistant Staphylococcus aureus (MRSA) Enterocolitis Treated With Oral Vancomycin
Ariana R Tagliaferri1, Mohamed Elagami1, Gabriel Melki2
1Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA.
Abstract:
Historically, methicillin-resistant Staphylococcus aureus (MRSA) was thought to be the primary pathogen in pseudomembranous enterocolitis associated with antibiotic use or recent abdominal surgery; however, Clostridioides difficile was later identified as another more common pathogen. Since the eclipse of C. difficile the workup of hospital-acquired diarrhea now utilizes nucleic acid amplification rather than stool cultures and longer includes the investigation of other less common pathogens. Consequently, the diagnosis of MRSA enterocolitis has faded. It is imperative to consider more sinister pathogens not routinely covered in laboratory testing as MRSA enterocolitis infections have been known to progress to severe systemic infections and thus the delay or misdiagnosis can result in inappropriate treatment, prolonged hospitalizations, sepsis and/or death. Herein we present a case of a patient who presented with laboratory diagnosed MRSA enterocolitis in the absence of recent abdominal surgery or antibiotic use and was successfully treated with oral vancomycin.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) can cause enterocolitis, even without typical risk factors like recent surgery or antibiotic use. Early diagnosis and treatment with oral vancomycin are crucial for successful outcomes.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Clinical Microbiology
Background:
- Historically, methicillin-resistant Staphylococcus aureus (MRSA) was considered a primary cause of antibiotic-associated pseudomembranous enterocolitis.
- Clostridioides difficile is now recognized as a more common pathogen, leading to a decreased focus on MRSA enterocolitis.
- Current diagnostic methods for hospital-acquired diarrhea often overlook less common pathogens like MRSA.
Observation:
- A case of MRSA enterocolitis was diagnosed in a patient without a history of recent abdominal surgery or antibiotic exposure.
- This presentation highlights the potential for MRSA enterocolitis to occur in atypical circumstances.
- The patient's condition progressed despite initial diagnostic pathways not prioritizing MRSA.
Findings:
- MRSA enterocolitis can manifest in patients lacking typical risk factors.
- Prompt identification and treatment of MRSA enterocolitis are essential for favorable outcomes.
- Oral vancomycin proved effective in treating this case of MRSA enterocolitis.
Implications:
- Clinicians must maintain a high index of suspicion for MRSA enterocolitis, even in the absence of common risk factors.
- Diagnostic workups for enterocolitis should consider a broader range of pathogens beyond C. difficile.
- Delayed or missed diagnosis of MRSA enterocolitis can lead to severe systemic infections, prolonged hospitalization, sepsis, and mortality.
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