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

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. 假膜性结肠炎的CT诊断. 放射学实践, 2009, 24(5): 577-578.
4.	王海红, 付蕾, 王昕, 等. 28例伪膜性肠炎的内镜及临床特点分析. 胃肠病学和肝病学杂志, 2012, 21(9): 807-809.
5.	王一鸣, 熊毅敏, 郑国荣, 等. 伪膜性肠炎的内镜与临床特征研究. 中国内镜杂志, 2003, 9(5): 89-90.
6.	陈荣, 罗燕萍, 叶丽艳, 等. 应用显色培养基快速检测血培养中耐甲氧西林金黄色葡萄球菌. 中华医院感染学杂志, 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.	张桂香, 陈汉忠, 罗志鸿, 等. 假膜性肠炎的CT诊断. 放射学实践, 2014, 29(4): 416-418.
15.	陈颖, 蔡庆. 伪膜性结肠炎的CT表现. 中国CT和MRI杂志, 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感染用药分析. 现代医院, 2008, 8(10): 19-21.
18.	秦新裕, 吴文川. MRSA感染的治疗. 中国普外基础与临床杂志, 2010, 17(11): 1120-1122.
19.	陈红旗, 杨俊, 周玉坤, 等. 益生菌对炎性肠病小鼠肠屏障功能的影响. 中国普外基础与临床杂志, 2011, 18(12): 1242-1247.
20.	秦环龙, 陈红旗. 微生态制剂在炎症性肠病治疗中的应用. 中国实用外科杂志, 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.	肖咏梅, 王佳怡, 车艳然, 等. 粪便微生物移植治疗幼儿重症伪膜性肠炎1例并文献复习. 中国循证儿科杂志, 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.

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. 假膜性结肠炎的CT诊断. 放射学实践, 2009, 24(5): 577-578.
4. 王海红, 付蕾, 王昕, 等. 28例伪膜性肠炎的内镜及临床特点分析. 胃肠病学和肝病学杂志, 2012, 21(9): 807-809.
5. 王一鸣, 熊毅敏, 郑国荣, 等. 伪膜性肠炎的内镜与临床特征研究. 中国内镜杂志, 2003, 9(5): 89-90.
6. 陈荣, 罗燕萍, 叶丽艳, 等. 应用显色培养基快速检测血培养中耐甲氧西林金黄色葡萄球菌. 中华医院感染学杂志, 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. 张桂香, 陈汉忠, 罗志鸿, 等. 假膜性肠炎的CT诊断. 放射学实践, 2014, 29(4): 416-418.
15. 陈颖, 蔡庆. 伪膜性结肠炎的CT表现. 中国CT和MRI杂志, 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感染用药分析. 现代医院, 2008, 8(10): 19-21.
18. 秦新裕, 吴文川. MRSA感染的治疗. 中国普外基础与临床杂志, 2010, 17(11): 1120-1122.
19. 陈红旗, 杨俊, 周玉坤, 等. 益生菌对炎性肠病小鼠肠屏障功能的影响. 中国普外基础与临床杂志, 2011, 18(12): 1242-1247.
20. 秦环龙, 陈红旗. 微生态制剂在炎症性肠病治疗中的应用. 中国实用外科杂志, 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. 肖咏梅, 王佳怡, 车艳然, 等. 粪便微生物移植治疗幼儿重症伪膜性肠炎1例并文献复习. 中国循证儿科杂志, 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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