[Clinical spectrum of antibiotic associated enterocolitis due to methicillin resistant Staphylococcus aureus]

Abstract

Historically, various types of antibiotic-associated diarrhea have been recognized. In the 1950-1960s, multi-resistant Staphylococcus aureus was implicated to be major cause of antibiotic-associated diarrhea, especially pseudomembranous enterocolitis. In the late 1970s, a new type of antibiotic-associated diarrhea, which is characterized by pseudomembranous colitis and lack of fecal multi-resistant S. aureus, usually following lincosamide administration, was recognized. Many studies have revealed the pathogenic roles of Clostridium difficile in these patients. Recent emergence of methicillin resistant S. aureus (MRSA) provokes another type of antibiotic-associated diarrhea. We have tried to isolate S. aureus and C. difficile from 150 faecal samples of patients with antibiotic-associated diarrhea. S. aureus alone was isolated from 32 (21.3%) samples. C. difficile alone was isolated from 51 (34.0%) samples, and, both were detected in 23 (15.3%) samples. 90.9% of S. aureus were MRSA. Comparing the clinical features of these cases, patients with both C. difficile and MRSA showed more serious clinical features. The patients who had undergone laparotomy were accompanied by shock and meteorism, more often than patients without laparotomy. The management of antibiotic-associated diarrhea due to MRSA is discussed.