Postoperative enteritis caused by methicillin-resistantStaphylococcus aureus

Kodama, Takashi; Santo, Takahiro; Yokoyama, Takashi; Takesue, Yoshio; Hiyama, Eiso; Imamura, Yuji; Murakami, Yoshiaki; Shinbara, Kanae; Tatsumoto, Nobuhide; Matsuura, Yuichirou

doi:10.1007/bf02385272

Cited by 38 publications

(32 citation statements)

References 19 publications

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“…For example, Squier et al found that patients in an intensive care unit or transplant unit who had both rectal and nasal carriage were significantly more likely to develop S. aureus infection than those with nasal carriage only (34). Furthermore, a number of investigators have reported that predominant growth of enterotoxin-producing strains of MRSA in the stool may in some instances be associated with development of enterocolitis or antibiotic-associated diarrhea (10,16,17,20,21,23,35,36,41). Despite these reports, MRSA has seldom been reported as a cause of enterocolitis or antibiotic-associated diarrhea in the United States (7,28,32).…”

Section: Discussionmentioning

confidence: 99%

Frequency and Possible Infection Control Implications of Gastrointestinal Colonization with Methicillin-Resistant Staphylococcus aureus

2005

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Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of health care-associated infections. Multiple factors, including transmission from unrecognized reservoirs of MRSA, are responsible for failure to control the spread of MRSA. We conducted prospective surveillance to determine the frequency of gastrointestinal colonization with MRSA among patients and its possible impact on nosocomial transmission of MRSA. Stool specimens submitted for Clostridium difficile toxin A/B assays were routinely inoculated on colistinnaladixic acid agar plates, and S. aureus was identified by using standard methods. Methicillin resistance was confirmed by growth on oxacillin-salt screening agar. For patients whose stool yielded MRSA, information regarding any previous cultures positive for MRSA or other organisms that would require contact precautions was obtained from the laboratory's computer system. During a 1-year period, 151 (9.8%) of 1,543 patients who had one or more stool specimens screened had MRSA in their stool. Ninety-three ( Screening of patients at high risk of colonization by methicillin-resistant Staphylococcus aureus (MRSA) has been recommended as a measure for controlling transmission of the organism in health care settings (24). Culture of specimens from the anterior nares and other body sites, such as wounds from high-risk individuals, often identifies patients with unrecognized MRSA colonization (9,12,19,38). Although gastrointestinal tract colonization by MRSA has been reported previously (4, 10, 29), culturing the stool specimens of patients who have been hospitalized for more than 3 days for potential pathogens is generally not recommended (33, 39). We conducted prospective surveillance of stool specimens in a hospital where MRSA is highly endemic to determine the frequency of MRSA gastrointestinal colonization among high-risk patients. A secondary aim of the study was to determine if recognition of gastrointestinal colonization by MRSA would affect the implementation of barrier precautions designed to reduce the spread of MRSA. MATERIALS AND METHODSAs part of ongoing surveillance for MRSA in a 450-bed university-affiliated teaching hospital, all stool specimens submitted to the clinical microbiology laboratory for Clostridium difficile toxin A/B testing were inoculated onto colistinnaladixic acid (CNA) agar plates that were incubated under aerobic conditions at 36°C overnight. This approach was taken because it seemed likely that patients at risk of antibiotic-associated diarrhea due to C. difficile would also be at increased risk of carrying other resistant pathogens such as MRSA. Colonies growing on CNA agar with morphology characteristic of S. aureus were identified by using coagulase tests. Those identified as S. aureus were inoculated onto commercially available oxacillin-salt screening agar (BBL, Cockeysville, MD), and those capable of growing on oxacillin-salt screening agar were classified as MRSA. The number of colonies of MRSA growing on CNA plates was recorded as 1ϩ to 4ϩ, with 4ϩ re...

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Section: Discussionmentioning

confidence: 99%

Frequency and Possible Infection Control Implications of Gastrointestinal Colonization with Methicillin-Resistant Staphylococcus aureus

2005

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“…The finding that MRSA enteritis isolates show increased production of SE-A and TSST-1 is supported by other studies. 11,21 However, they also found that the majority of enteritis isolates were actually SE-A/SE-C co-producing strains. This may represent genetic variation in different centres.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] The biological mechanism by which MRSA enteritis is lethal is not completely understood. A murine model suggests that the production of endotoxin and the translocation of E. coli are important in the fatality of MRSA enteritic rats; 10 in humans, it has been shown that MRSA can produce endo-and exotoxins which subsequently translocate across the GIT mucosa into the bloodstream thus inducing various biological responses, 11 such as production of interleukins 1 and 2 and tumour necrosis factor-α (TNF-α).…”

Section: Discussionmentioning

confidence: 99%

MRSA Enteritis Causing a High Stoma Output in the Early Postoperative Phase After Bowel Surgery

Haq

Cook

2007

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

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“…Staphylococcal enterotoxin typing, coagulase typing, and toxic shock syndrome toxin 1 (TSST-1) titers are used as markers of MRSA enteritis (10,30,31). Many studies have described the phenotypes of isolates that cause enteritis, but there have been only a few reports on the genomic analysis of MRSA strains that cause enteritis (36).…”

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confidence: 99%

“…The production of TSST-1 and staphylococcal enterotoxin is thought to be associated with the occurrence of MRSA enteritis (10). The mechanism of their production is complicated, but it seems clear that the production of these enterotoxins and the virulence of the MRSA strains are controlled by the agr locus (23,25,37).…”

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Changes in the agr Locus Affect Enteritis Caused by Methicillin-Resistant Staphylococcus aureus

et al. 2009

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We studied the characteristics of methicillin (meticillin)-resistant Staphylococcus aureus (MRSA) strains that caused enteritis. In a previous report, we demonstrated that both phenotypic and genotypic changes were associated with MRSA enteritis; and we hypothesized that the accessory gene regulator (agr), which is a global regulator of staphylococcal virulence and upregulates several exoproteins, is the key factor associated with the development of MRSA enteritis. In this study, we examined 12 MRSA isolates associated with enteritis from stool samples and 17 MRSA isolates not associated with enteritis that had the following characteristics: the strains associated with enteritis had the same genotype (genotype A), as detected by pulsed-field gel electrophoresis, or the strains were isolated from stools. The differences between strains that caused enteritis and those that did not cause enteritis strains were examined by quantitative reverse transcription-PCR to assess RNAII, agrA, RNAIII, and tst expression and by sequencing of the agr locus. The levels of expression of agrA, RNAIII, and tst were higher by the MRSA isolates associated with enteritis than by the MRSA isolates not associated with enteritis, whether or not they were of the same genotype. The levels of expression of RNAII by almost all the clinical isolates were similar. Sequencing of the agr locus showed that all MRSA isolates that caused enteritis have agr mutations, whereas the MRSA isolates that did not cause enteritis, with three exceptions, did not. Many of the isolates associated with enteritis had the same mutation, especially at the C-terminal end of agrA. These results suggest a trend in which mutations in the agr locus modify the expression of agrA and RNAIII and the production of toxin, all of which may increase the virulence and influence the occurrence of MRSA enteritis.Severe postsurgical enteritis caused by methicillin (meticillin)-resistant Staphylococcus aureus (MRSA) (MRSA enteritis) was prevalent in Japan in the early 1990s. In the late 1990s, most patients with MRSA enteritis were successfully treated with vancomycin, and the number of cases with MRSA enteritis gradually decreased, but whenever it occurred, it was associated with a severe clinical course and, occasionally, death (12,28).Several studies have discussed the characteristics of isolates causing MRSA enteritis. Staphylococcal enterotoxin typing, coagulase typing, and toxic shock syndrome toxin 1 (TSST-1) titers are used as markers of MRSA enteritis (10, 30, 31). Many studies have described the phenotypes of isolates that cause enteritis, but there have been only a few reports on the genomic analysis of MRSA strains that cause enteritis (36). Our laboratory has studied the molecular epidemiology of MRSA enteritis strains by using pulsed-field gel electrophoresis (PFGE) and other methodologies for more than three decades. Our work has provided evidence that the disappearance of MRSA enteritis may have resulted from the decreased incidence of enteritis-causing clones (21)...

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Postoperative enteritis caused by methicillin-resistantStaphylococcus aureus

Cited by 38 publications

References 19 publications

Frequency and Possible Infection Control Implications of Gastrointestinal Colonization with Methicillin-Resistant Staphylococcus aureus

Frequency and Possible Infection Control Implications of Gastrointestinal Colonization with Methicillin-Resistant Staphylococcus aureus

MRSA Enteritis Causing a High Stoma Output in the Early Postoperative Phase After Bowel Surgery

Changes in the agr Locus Affect Enteritis Caused by Methicillin-Resistant Staphylococcus aureus

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