The Clinical Analysis of Methicillin-Resistant Staphylococcus Aureus-Associated Enteritis in 21 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YINDong-zhi ¹ ,  YUANYou-neng ¹ , ZUOYan-ni ¹ , WANGYan-wu ² , ZUOJian ¹

1. Department of Gastrointestinal Surgery, Huangshi Center Hospital, Huangshi 43500, Hubei Province, China;
2. Department of Pathology, Huangshi Center Hospital, Huangshi 435000, Hubei Province, China;

Corresponding?author：

YUANYou-neng, Email: yuanyouneng@126.com

Keywords：

Methicillin-resistant Staphylococcus aureus; Enteritis; Clinical analysis

DOI：

10.7507/1007-9424.20160087

Video：

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Objective To summarize the clinical features and experience of Methicillin-resistant Staphylococcus aureus (MRSA)-associated enteritis. Methods Clinical data of 21 patients with MRSA-associated enteritis who were treated in our hospital from Jan. 2003 to May. 2015 were analyzed retrospectively. Results After diagnosed or suspected of MRSA-associated enteritis, the 21 patients received a drug therapy with vancomycin instead of other antibiotic, 3 patients (14.3%) who failed to get satisfactory symptom relief received a plus therapy with biapenem; 13 patients (61.9%) received treatment which plus drugs such as Bacillus licheniformis capsules or combining Bifidobacterium to regulate intestinal microflora. Severe complications, such as intestinal fistula (8 patients, 38.1%）, toxic shock (16 patients, 76.2%）, organ system failure (14 patients, 66.7%) occurred in 17 patients (80.9%) of the 21 patients when 2-7 days (mean of 4.7 days) after diarrhea. Among 21 patients received therapy, 7 patients (33.3%) were cured and 2 patients (9.5%) were improved, whereas 11 patients died, with a total mortality of 52.4%, another 1 patient was lost to follow up (4.8%). There were 8 patients who were followed-up for 1-12 months (the median time was 3.1-month). During the followed-up period, 2 of them died and others stayed alive without occurrence. Conclusion Although uncommon, MRSA-associated enteritis progressed rapidly, with many complications and high mortality rate. Early diagnosis and timely targeted treatment restoring the balance of gastrointestinal microecology are the key to decrease its mortality.

Citation： YINDong-zhi, YUANYou-neng, ZUOYan-ni, WANGYan-wu, ZUOJian. The Clinical Analysis of Methicillin-Resistant Staphylococcus Aureus-Associated Enteritis in 21 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(3): 328-332. doi: 10.7507/1007-9424.20160087 Copy

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1. Aslam S, Musher DM. An update on diagnosis, treatment, and prevention of Clostridium difficile-associated disease. Gastroenterol Clin North Am, 2006, 35(2): 315-335.
2. Fekty R. Guidelines for the diagnosis and management of Clostri-dium difficile-associated diarrhea and colitis. American College of Gastroenterology, Practice Parameters Committee. Am J Gastroen-terol, 1997, 92(5): 739-750.
3. Schulze M, Fritz J, Joanoviciu SD, 等. 假膜性結腸炎的CT診斷. 放射學實踐, 2009, 24(5): 577-578.
4. 王海紅, 付蕾, 王昕, 等. 28例偽膜性腸炎的內鏡及臨床特點分析. 胃腸病學和肝病學雜志, 2012, 21(9): 807-809.
5. 王一鳴, 熊毅敏, 鄭國榮, 等. 偽膜性腸炎的內鏡與臨床特征研究. 中國內鏡雜志, 2003, 9(5): 89-90.
6. 陳榮, 羅燕萍, 葉麗艷, 等. 應用顯色培養基快速檢測血培養中耐甲氧西林金黃色葡萄球菌. 中華醫院感染學雜志, 2012, 22(13): 2949-2951.
7. Lo TS, Borchardt SM. Antibiotic-associated diarrhea due to methici-llin-resistant Staphylococcus aureus. Diagn Microbiol Infect Dis, 2009, 63(4): 388-389.
8. Takesue Y, Yokoyama T, Kodama T, et al. A study on postoperative enteritis caused by methicillin-resistant Staphylococcus aureus. Surg Today, 1993, 23(1): 4-8.
9. Hempel S, Newberry SJ, Maher AR, et al. Probiotics for the preven-tion and treatment of antibiotic-associated diarrhea a systematic review and meta-analysis. JAMA, 2012, 307(18): 1959-1969.
10. Song HJ, Shim KN, Jung SA, et al. Antibiotic-associated diarrhea: candidate organisms other than Clostridium difficile. Korean J Intern Med, 2008, 23(1): 9-15.
11. Dinges MM, Orwin PM, Schlievert PM. Exotoxins of Staphylococcus aureus. Clin Microbiol Rev, 2000, 13(1): 16-34.
12. Causey MW, Spencer MP, Steele SR. Clostridium difficile enteritis after colectomy. Am Surg, 2009, 75(12): 1203-1206.
13. Takeuchi K, Tsuzuki Y, Ando T, et al. Clinical studies of enteritis caused by methicillin-resistant Staphylococcus aureus. Eur J Surg, 2001, 167(4): 293-296.
14. 張桂香, 陳漢忠, 羅志鴻, 等. 假膜性腸炎的CT診斷. 放射學實踐, 2014, 29(4): 416-418.
15. 陳穎, 蔡慶. 偽膜性結腸炎的CT表現. 中國CT和MRI雜志, 2011, 9(6): 13-15.
16. Gemmell CG, Edwards DI, Fraise AP, et al. Guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the UK. J Antimicrob Chemother, 2006, 57(4): 589-608.
17. 李松, 肖桂元, 周甘平, 等. MRSA感染用藥分析. 現代醫院, 2008, 8(10): 19-21.
18. 秦新裕, 吳文川. MRSA感染的治療. 中國普外基礎與臨床雜志, 2010, 17(11): 1120-1122.
19. 陳紅旗, 楊俊, 周玉坤, 等. 益生菌對炎性腸病小鼠腸屏障功能的影響. 中國普外基礎與臨床雜志, 2011, 18(12): 1242-1247.
20. 秦環龍, 陳紅旗. 微生態制劑在炎癥性腸病治療中的應用. 中國實用外科雜志, 2013, 33(7): 546-549.
21. Resta-Lenert S, Barrett KE. Live probiotics protect intestinal epithe-lial cells from the effects of infection with enteroinvasive Escherichia coli (EIEC). Gut, 2003, 52(7): 988-997.
22. Resta-Lenert S, Barrett KE. Probiotics and commensals reverse TNF-alpha-and IFN-gamma-induced dysfunction in human intestinal epithelial cells. Gastroenterology, 2006, 130(3): 731-746.
23. van Nood E, Vrieze A, Nieuwdorp M, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med, 2013, 368(5): 407-415.
24. 肖詠梅, 王佳怡, 車艷然, 等. 糞便微生物移植治療幼兒重癥偽膜性腸炎1例并文獻復習. 中國循證兒科雜志, 2014, 9(1): 37-40.
25. Ramsing BG, Arpi M, Andersen EA, et al. First outbreak with MRSA in a Danish neonatal intensive care unit: risk factors and control procedures. PLoS One, 2013, 8(6): e66904.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The Clinical Analysis of Methicillin-Resistant Staphylococcus Aureus-Associated Enteritis in 21 Cases

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