Staphylococcus aureus and Clostridium difficile Cause Distinct Pseudomembranous Intestinal Diseases

Froberg, M. Kent; Palavecino, Elizabeth; Dykoski, Richard; Gerding, Dale N.; Peterson, Lance R.; Johnson, Stuart

doi:10.1086/423273

Cited by 36 publications

(36 citation statements)

References 12 publications

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“…Thus, S. aureus fecal testing may be applicable for patients with AAD of unknown cause and/or when S. aureus, particularly MRSA, has been isolated from another site. Froberg et al recently reported a case of simultaneous infections with C. difficile and S. aureus (MRSA) (17). The presence of discrete colonic pseudomembranes and confluent, loosely adherent ileal pseudomembranes suggested that separate pathological processes occur in these two types of AAD.…”

Section: Discussionmentioning

confidence: 99%

Comparative Analysis of Prevalence, Risk Factors, and Molecular Epidemiology of Antibiotic-Associated Diarrhea Due to Clostridium difficile , Clostridium perfringens , and Staphylococcus aureus

Tompkins²,

2006

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We prospectively studied the comparative epidemiology and risk factors for Clostridium difficile, Clostridium perfringens, and Staphylococcus aureus antibiotic-associated diarrhea (AAD). Four thousand six hundred fiftynine inpatient fecal specimens (11 months) were tested for C. difficile cytotoxin, C. perfringens enterotoxin, and S. aureus by Vero cell assay, enzyme-linked immunosorbent assay, and growth on fresh blood agar, respectively. Two distinct age-, sex-, and location-matched control patient groups were used for multivariate logistic regression risk factor analyses: symptomatic patients who were AAD pathogen negative and asymptomatic patients with histories of recent antimicrobial therapy. All AAD pathogen isolates were DNA fingerprinted. In AAD cases, the prevalences of C. difficile cytotoxin, C. perfringens enterotoxin, and S. aureus were 12.7%, 3.3%, and 0.2%, respectively (15.8% overall). Age of >70 years was a common risk factor. Other risk factors for infective AAD and C. difficile AAD included length of hospital stay and use of feeding tubes (length of stay odds ratios [OR], 1.017 and 1.012; feeding tube OR, 1.864 and 2.808). Female gender and use of antacids were significantly associated with increased risk of C. perfringens AAD (OR, 2.08 and 2.789, respectively), but unlike what was found for C. difficile AAD, specific antibiotic classes were not associated with increased risk. A limited number of genotypes caused the majority of C. difficile and C. perfringens AAD cases. Similar to what was found for C. difficile AAD, there was epidemiological evidence of C. perfringens AAD case clustering and reinfection due to different strains. C. difficile AAD was approximately 4 and 60 times more common than C. perfringens AAD and S. aureus AAD, respectively. Risk factors for these AAD pathogens differed, highlighting the need to define specific control measures. There is evidence of nosocomial transmission in cases of C. perfringens AAD.

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Section: Discussionmentioning

confidence: 99%

Comparative Analysis of Prevalence, Risk Factors, and Molecular Epidemiology of Antibiotic-Associated Diarrhea Due to Clostridium difficile , Clostridium perfringens , and Staphylococcus aureus

Tompkins²,

2006

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“…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). Recently, we reported 11 cases of antibiotic-associated diarrhea in patients whose stool specimens contained heavy growth of enterotoxin-producing strains of MRSA, with detectable amounts of staphylococcal enterotoxin in stool filtrates (1).…”

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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“…The basic mechanisms are quite enigmatic and the etiological processes are just beginning to be identified. For instance, Froberg et al [67] presented histo-pathological evidence for the existence of a specific S. aureus-induced pseudomembranous intestinal disease, distinct from that seen during C. difficile infection in an unusual case of simultaneous infection with C. difficile and MRSA. Whereas C. difficile induces colonic pseudomembranes, the MRSA infection induced loosely adherent pseudomembranes in the small bowel.…”

Section: Potential Role Of S Aureus In Intestinal Diseasementioning

confidence: 99%

Intestinal carriage of Staphylococcus aureus: how does its frequency compare with that of nasal carriage and what is its clinical impact?

Acton¹,

Plat-Sinnige

Wamel

et al. 2008

Eur J Clin Microbiol Infect Dis

214

162

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The bacterial species Staphylococcus aureus, including its methicillin-resistant variant (MRSA), finds its primary ecological niche in the human nose, but is also able to colonize the intestines and the perineal region. Intestinal carriage has not been widely investigated despite its potential clinical impact. This review summarizes literature on the topic and sketches the current state of affairs from a microbiological and infectious diseases' perspective. Major findings are that the average reported detection rate of intestinal carriage in healthy individuals and patients is 20% for S. aureus and 9% for MRSA, which is approximately half of that for nasal carriage. Nasal carriage seems to predispose to intestinal carriage, but sole intestinal carriage occurs relatively frequently and is observed in 1 out of 3 intestinal carriers, which provides a rationale to include intestinal screening for surveillance or in outbreak settings. Colonization of the intestinal tract with S. aureus at a young age occurs at a high frequency and may affect the host's immune system. The frequency of intestinal carriage is generally underestimated and may significantly contribute to bacterial dissemination and subsequent risk of infections. Whether intestinal rather than nasal S. aureus carriage is a primary predictor for infections is still ill-defined.

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Staphylococcus aureus and Clostridium difficile Cause Distinct Pseudomembranous Intestinal Diseases

Cited by 36 publications

References 12 publications

Comparative Analysis of Prevalence, Risk Factors, and Molecular Epidemiology of Antibiotic-Associated Diarrhea Due to Clostridium difficile , Clostridium perfringens , and Staphylococcus aureus

Comparative Analysis of Prevalence, Risk Factors, and Molecular Epidemiology of Antibiotic-Associated Diarrhea Due to Clostridium difficile , Clostridium perfringens , and Staphylococcus aureus

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

Intestinal carriage of Staphylococcus aureus: how does its frequency compare with that of nasal carriage and what is its clinical impact?

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