29 September 2020: Articles
A Case of Postoperative Methicillin-Resistant Enterocolitis in an 81-Year-Old Man and Review of the Literature
Rare disease
Kapil Gururangan A* , Marisa K. Holubar DDOI: 10.12659/AJCR.922521
Am J Case Rep 2020; 21:e922521
Table 1. Published cases and reports of Staphylococcus aureus enterocolitis in adults.
| Reference | Year | Country | N | MRSA | Predisposing factor | Diagnostic testing | Treatment | Notes |
|---|---|---|---|---|---|---|---|---|
| Gururangan and Holubar (this report) | 2016 | USA | 1 | Yes | AA, PS | CD test: (–) NAAT BCx: (+) MRSA SCx: (–) for SA ANS: (+) MRSA | PO+IV vancomycin, IV daptomycin | Patient developed MRSA bacteremia prior to diagnosis of proctocolitis, switched from IV vancomycin to IV daptomycin due to acute renal injury Outcome: Survival |
| Ackermann et al. []29 | 2005 | Germany | 25 | No | AA | CD test: (–) EIA in 24% SCx: (+) SA, 60% also (+) CD | NS | SCx (+) for SA in 25 of 89 (28%) patients with AA diarrhea Outcome: NS |
| Altemeier et al. []30 | 1963 | USA | 155 | NT | AA | CD test: NT SCx: (+) SA | Various anti-staphylococcal antibiotics, probiotics | 58 patients (37%) were PS Enterocolitis found in 17 of 32 autopsies Outcome: Survival in 107, death in 48 |
| Asha et al. []31 | 2006 | UK | 10 | Yes | AA | CD test: (–) cytotoxin assay SCx: (+) MRSA | NS | ≥1 pathogen detected in 735 of 4659 (16%) stool specimens; 10 (0.2%) grew SA; 591 (13%) had a (+) CD cytotoxin assay Outcome: NS |
| Avery et al. []32 | 2015 | USA | 1 | Yes | AA | CD test: (–) NAAT SCx: (+) MRSA | Vancomycin, probiotics | Final diagnosis was toxin-negative CD Outcome: Survival |
| Bae et al. []33 | 2011 | South Korea | 1 | Yes | AA | CD test: (–) NAAT LGIS: severe mucosal edema and (+) MRSA | Vancomycin | Subsequent lymphocytic colitis Outcome: Survival |
| Bergevin et al. []34 | 2017 | Canada | 1 | Yes | AA | CD test: (–) EIA SCx: (+) MRSA LGIS: diffuse acute colitis | Vancomycin | ANS (+) Outcome: NS |
| Bettenworth et al. []35 | 2013 | Germany | 1 | Yes | IBD | CD test: NT SCx: (–) for CD LGIS: acute Crohn’s colitis and (+) MRSA | Linezolid | ANS (–) and perianal swab (+) for MRSA Outcome: Survival |
| Boyce and Havill []24 | 2005 | USA | 11 | Yes | AA | CD test: (–) EIA SCx: (+) MRSA | Vancomycin | Patients with MRSA on SCx had greater average stool volume and number per day Patients with ET (–) MRSA had fewer days of diarrhea and stools per day Outcome: NS |
| Boyce et al. []36 | 2005 | USA | 151 | Yes | NS | CD test: NS (see notes) SCx: (+) MRSA | NS | 1543 patients tested for CD with EIA, 159 (10%) (+)EIA and 151 (9.8%) (+) SCx for MRSA Number of patients with both MRSA and CD was not reported Outcome: NS |
| Brown et al. []9 | 1953 | USA | 2 | NT | AA, PS | CD test: NT Autopsy: PM colitis and (+) SA | Terramycin, streptomycin, sulfisoxazole, aureomycin | Both patients were also reported by Wakefield and Sommers [] Outcome: Death in 210 |
| Cheng et al. []37 | 2006 | Australia | 1 | Yes | AA, PS | CD test: (–) cytotoxin assay SCx: (+) MRSA | Vancomycin | Outcome: Survival |
| Chubachi et al. []38 | 1993 | Japan | 1 | Yes | Neutropenia | CD test: NT SCx and BCx: (+) MRSA | Vancomycin | Patient developed sepsis and respiratory distress Outcome: Survival |
| Clarke and Baidoo []39 | 2012 | USA | 1 | Yes | Healthcare worker | SCx: (+) MRSA, (–) CD LGIS: pancolitis | Vancomycin | Outcome: Survival |
| Cope et al. []40 | 1953 | USA | 1 | No | AA, PS | CD test: NT BCx: (+) SA Autopsy: PM colitis and (+) SA | Aureomycin | Outcome: Death |
| Dalal and Urban []41 | 2008 | USA | 2 | Yes | AA | CD test: (–) cytotoxin assay BCx: no growth SCx: (+) MRSA | Vancomycin, piperacillin-tazobactam | Both patients presented with sepsis Outcome: Survival in 2 |
| Dickinson et al. []42 | 1980 | UK | 2 | No | AA, IBD | CD test: NT SCx: (+) SA LGIS: normal | Steroids | CD culture and cytotoxin assay were not sought Outcome: Survival in 2 |
| Estifan et al. []`43 | 2019 | USA | 1 | Yes | AA | CD test: (–) NS SCx: (+) MRSA | Vancomycin, trimethoprim-sulfamethoxazole | Patient had type 1 diabetes and presented in diabetic ketoacidosis Imaging showed acute appendicitis Outcome: Survival |
| Fairlie and Kendall []44 | 1953 | USA | 5 | NT | AA, PS | CD test: NT Autopsy (+) SA | Penicillin, dihydro-streptomycin, aureomycin, oxytetracycline | Outcome: Survival in 2, death in 3 |
| Flemming and Ackermann []45 | 2007 | Germany | 198 | Yes/No | AA, hospital stay ≥72 hours | CD test: (+) EIA in 25 SCx: (+) MSSA (85%) or MRSA (15%) | NS | 121 of 2727 (4%) (+) for CD 198 of 2727 (7%) (+) for SA, of which 29 (15%) were MRSA Outcome: NS |
| Froberg et al. []1 | 2004 | USA | 1 | Yes | AA | CD test: (+) cytotoxin assay BCx: (+) MRSA SCx: (+) MRSA and CD Autopsy: 2 PM lesions, one with SA and one with CD | Vancomycin, metronidazole, amikacin | Autopsy also showed colonic perforation Outcome: Survival |
| Furukawa et al. []46 | 2015 | Japan | 1 | Yes | AA, PS | CD test: (–) EIA SCx: (+) MRSA Pathology: (+) SA | Vancomycin | Emergent laparotomy was performed, revealed cecum perforation Outcome: Survival |
| Gravet et al. []47 | 1999 | France | 60 | Yes/No | AA | CD test: (+) cytotoxin assay and culture in 4 patients SCx: (+) SA, MRSA in 92% | Vancomycin | Outcome: NS |
| Kalakonda et al. []48 | 2016 | USA | 1 | Yes | None | CD test: (–) NAAT BCx: no growth SCx: (+) MRSA LGIS: PM colitis | Vancomycin | Patient presented in sepsis Initial SCx had no growth, repeat SCx (+) for MRSA Outcome: Survival |
| Kodama et al. []49 | 1997 | Japan | 14 | Yes | AA, PS | CD test: NT SCx: (+) MRSA | Vancomycin | 13 of 14 (93%) strains were ET-producing Outcome: NS |
| Konishi et al. []50 | 1997 | Japan | 31 | Yes | PS | CD test: NT SCx: (+) MRSA, 4 also grew CD in small numbers | Vancomycin | IV antibiotics were given to 19 of 31 patients, 6 received IV vancomycin Outcome: Survival in 31 |
| Kotler et al. []51 | 2007 | USA | 1 | No | HIV, AA | CD test: (–) cytotoxin assay SCx: (+) SA LGIS: acute colitis | Vancomycin, cefepime, octreotide | Patient developed toxic-shock syndrome, SA was ET-producing Outcome: Survival |
| Lane et al. []52 | 2018 | USA | 1 | Yes | AA | CD test: (–) NAAT SCx: (+) MRSA UCx: (+) MRSA | PO+IV vancomycin | Urine and stool MRSA isolates were found to be genetically identical Outcome: Survival |
| Lepley and Smith []53 | 1957 | USA | 16 | NT | AA, PS | CD test: NT SCx: (+) SA | Chloramphenicol, erythromycin | Outcome: NS |
| Lieverse et al. []54 | 2001 | Netherlands | 2 | No | Sick contact | CD test: NT BCx: no growth Gastric fluid, elbow aspirate: (+) SA | Ciprofloxacin or gentamicin | Husband with elbow wound growing SA, wife changed his bandages Wife expired, laparotomy showed multiple bowel perforations Outcome: Death in 2 |
| Lo and Borchardt []55 | 2009 | USA | 5 | Yes | AA | CD test: (–) EIA SCx: (+) MRSA | Vancomycin | One patient improved without antibiotics Outcome: Survival in 5 |
| McPherson et al. []56 | 2005 | UK | 1 | Yes | AA, PS | CD test: (–) EIA SCx: (+) MRSA Wound culture: (+) MRSA LGIS: normal | Vancomycin, doxycycline | Outcome: Survival |
| Ogawa et al. []57 | 2014 | Japan | 1 | Yes | AA | CD test: (–) NAAT SCx: (+) MRSA BCx: (+) MRSA Synovial fluid: (+) MRSA | Vancomycin | Presented in sepsis, which resolved prior to diarrhea onset Septic arthritis diagnosed followed treatment Outcome: Survival |
| Okada et al. []58 | 2018 | Japan | 1 | Yes | PS | SCx: (–) CD, (+) MRSA | Vancomycin, metronidazole, rifampicin | MRSA strain was resistant to vancomycin Outcome: Survival |
| Pressly et al. []59 | 2016 | USA | 1 | Yes | IBD | CD test: (–) NAAT SCx: (+) MRSA LGIS: PM colitis | Vancomycin | Patient reported eating deviled eggs prior to symptom onset Outcome: Survival |
| Rhee et al. []60 | 2004 | USA | 1 | Yes | AA | CD test: (–) EIA SCx: (+) MRSA | Vancomycin | Outcome: Survival |
| Rogers et al. []61 | 2019 | USA | 1 | Yes | AA | CD test: (–) EIA SCx: (+) MRSA | PO+IV vancomycin, piperacillin-tazobactam | Patient diagnosed with acute diverticulitis Outcome: Survival |
| Rothman et al. []62 | 2018 | USA | 1 | Yes | HIV, AA | CD test: NS SCx: (+) MRSA BCx: (+) MRSA | Vancomycin, cefepime, azithromycin | Presented with enterocolitis in the setting of newly diagnosed acute myeloid leukemia Initial SCx (+) for MRSA felt to be insignificant until symptoms persisted and patient developed septic shock Outcome: Death |
| Shah et al. []63 | 2016 | USA | 1 | No | AA, IBD | CD test: (–) cytotoxin assay SCx: (+) SA | Vancomycin | Outcome: Survival |
| Schiller et al. []64 | 1998 | USA | 1 | Yes | AA | CD test: (–) EIA BCx: no growth SCx: (+) MRSA | Vancomycin | Outcome: Survival |
| Sizemore et al. []65 | 2012 | USA | 1 | Yes | AA, PS | CD test: (–) NAAT SCx: (+) MRSA | Vancomycin, mupirocin, probiotic | ANS (+) Outcome: Survival |
| Sonpal et al. []66 | 2010 | USA | 1 | Yes | IDB | CD test: (–) cytotoxin assay SCx: (+) MRSA | Vancomycin | Outcome: Survival |
| Speare []67 | 1954 | USA | 8 | NT | AA, PS | CD test: NT SCx: (+) SA | Aureomycin, magnamycin, sulfadiazine | Outcome: Survival in 3, death in 5 |
| Takesue et al. []68 | 1993 | Japan | 10 | Yes | PS | CD test: NT Sputum, drain, stool, skin, blood culture: (+) MRSA in 138 samples | NS | 10 of 503 (2%) PS patients developed MRSA enteritis Outcome: Survival in 10 |
| Takeuchi et al. []69 | 2001 | Japan | 17 | Yes | AA, PS | CD test: NT Gastric juice, drain output, or SCx: (+) MRSA | Vancomycin | Outcome: Survival in 15, death in 2 |
| Taylor et al. []70 | 1993 | UK | 1 | Yes | AA, IBD | CD test: (–) EIA SCx: (+) MRSA, (–) CD | Vancomycin | Outcome: Survival |
| Thakkar and Agrawal []71 | 2010 | USA | 1 | NT | AA | CD test: NT SCx: (+) SA LGIS: chronic active necrotizing colitis | Levofloxacin, metronidazole, proton-pump inhibitor | Exploratory laparotomy showed toxic megacolon, and Gram stain of surgical specimens showed gram-positive cocci in clusters Discharged without postoperative antibiotic therapy Outcome: Survival |
| Wakefield and Sommers []10 | 1953 | USA | 3 | NT | AA, PS | CD test: NT Autopsy: intestinal lining and heart BCx (+) SA | Streptomycin, terramycin, sulfisoxazole, aureomycin, penicillin | Two patients were also reported by Brown et al. [] Outcome: Death in 39 |
| Wallace et al. []72 | 1965 | USA | 7 | NT | AA, PS | CD test: NT SCx: (+) SA | Vancomycin | SA strains resistant to penicillin G Outcome: Survival in 7 |
| Watanabe et al. []73 | 2001 | Japan | 13 | Yes | AA, PS | CD test: (–) EIA Sputum, pharynx, nasal, gastric juice, or stool culture: (+) MRSA in all 45 samples | NS | 12 of 13 (92%) patients had MRSA isolates from respiratory and digestive cultures with identical or near-identical molecular characteristics Outcome: NS |
| Wei et al. []74 | 2015 | China | 5 | Yes | AA, IBD, PS | SCx: (–) CD Gastric juice culture: (+) MRSA | Fecal microbiota transplantation | Outcome: Survival in 5 |
| Yoshida et al. []75 | 1992 | Japan | 2 | Yes | AA, PS | CD test: NT SCx: (+) MRSA | Vancomycin | Outcome: Survival in 2 |
| Includes reports published in English language; for reports published in Japanese, please see the systematic review by Iwata and colleagues []. AA – antibiotic-associated; ANS – anterior nares screen for MRSA; BCx – blood culture; CD – ; EIA – enzyme immunoassay for antigen (glutamate dehydrogenase) and toxin; LGIS – lower gastrointestinal scope, including colonoscopy or sigmoidoscopy; ET – enterotoxin; IBD – inflammatory bowel disease; IV – intravenous; MRSA – methicillin-resistant S. ; N – number of patients with ; NAAT – nucleic acid amplification test (including polymerase chain reaction); NS – not specified; NT – not tested; PM – pseudomembranous; PO – per os (oral administration); PS – postsurgical; SA – ; SCx – stool culture; UK – United Kingdom; USA – United States of America. | ||||||||