Methicillin-resistant Staphylococcus aureus enterocolitis sequentially complicated with septic arthritis: a case report and review of the literature

BMC Research Notes

Hajime Goto³  Hajime Takizawa³  Shota Yonetani¹  Hiroshi Makino¹  Koji Araki¹  Kosuke Ohkuma³  Ken Kikuchi²  Takashi Koide³  Takeshi Saraya³  Yukari Ogawa³ 

[1]Department of Clinical Laboratory, Kyorin University School of Medicine, Tokyo, Japan

[2]Department of Infection Control Science, Faculty of Medicine, Juntendo University, Tokyo, Japan

[3]Department of Respiratory Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan

关键词: Multilocus sequence typing;    Fecal leukocytes;    Methicillin-resistant Staphylococcus aureus;   

Others  :  1134876
DOI  :  10.1186/1756-0500-7-21

 received in 2013-09-18, accepted in 2014-01-03,  发布年份 2014

【 摘 要 】

Background

Although most reports describing patients infected with methicillin-resistant Staphylococcus aureus enterocolitis have been published in Japan, this concept remains a matter of debate and diagnostic criteria have not yet been defined.

Case presentation

The general status of a 74-year-old Japanese man referred to our hospital (day 1) with severe community-acquired pneumococcal pneumonia gradually improved with antibiotic therapy. Thereafter, up to 4 L/day of acute watery diarrhea that started on day 19 was refractory to metronidazole but responded immediately to oral vancomycin. Gram staining stool samples was positive for abundant fecal leukocytes from which dominant methicillin-resistant Staphylococcus aureus (10⁴ CFU/mL) were isolated, suggesting methicillin-resistant Staphylococcus aureus enterocolitis. High fever with methicillin-resistant Staphylococcus aureus bacteremia was evident at day 30, and suppurative right hip arthritis developed around day 71. All methicillin-resistant Staphylococcus aureus strains isolated from stools, blood and aspirated synovial fluid separated in the same manner on pulsed-field gel electrophoresis, as well as two other strains isolated from sputum, belonged to the same clone as sequence type (ST) 764 (complex clonal 5), and carried SCCmec type II.

Conclusion

The clinical, microbiological and molecular biological findings of this patient indicated methicillin-resistant Staphylococcus aureus enterocolitis that led to septic methicillin-resistant Staphylococcus aureus arthritis.

【 授权许可】

   
2014 Ogawa et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Tenover FC, Arbeit RD, Goering RV, Mickelsen PA, Murray BE, Persing DH, Swaminathan B: Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995, 33(9):2233-2239.
• [2]Case definitions for infectious conditions under public health surveillance. Centers for disease control and prevention MMWR Recomm Rep 1997, 46(RR-10):1-55. http://www.ncbi.nlm.nih.gov/pubmed/9148133 webcite
• [3]Multi Locus Sequence Typing home page. http://www.mlst.net/ webcite
• [4]Morita H, Tani M, Adachi H, Kawai S: Methicillin-resistant Staphylococcus aureus (MRSA) enteritis associated with prophylactic cephalosporin administration and hypochlorhydria, after subtotal gastrectomy. Am J Gastroenterol 1991, 86(6):791-792.
• [5]Hori K, Yura J, Shinagawa N, Sakurai S, Mashita K, Mizuno A: Postoperative enterocolitis and current status of MRSA enterocolitis–the result of a questionnaire survey in Japan. Kansenshogaku Zasshi 1989, 63(7):701-707.
• [6]Boyce JM, Havill NL: Nosocomial antibiotic-associated diarrhea associated with enterotoxin-producing strains of methicillin-resistant Staphylococcus aureus. Am J Gastroenterol 2005, 100(8):1828-1834.
• [7]Fujita K, Honda Y, Kurihara T, Ohba H, Okimoto N: A case of pseudomembranous enterocolitis caused by methicillin-resistant Staphylococcus aureus. J J A Inf D 2004, 78:905-909.
• [8]Ohkouchi S, Gomi K, Tokue Y, Kikuchi T, Fujimura S, Nukiwa T, Watanabe A: Sepsis caused by methicillin-resistant Staphylococcus aureus (MRSA) without effects of vancomycin (VCM), teicoplanin (TEIC) and arbekacin (ABK) treated successfully and safely with intravenous administration of linezolid (LZD). Jpn J Chemother 2004, 52(12):787-792.
• [9]Tei M, Shimizu J, Ikeda K, Kitada M, Shimano T: Whole digestive tract infection caused by methicillin-resistant Staphylococcus aureus after appendectomy. J Jpn Surg Assoc 2006, 67(8):1739-1743.
• [10]Hamada Y, Imaizumi H, Watanabe M, Kikuchi H, Watanabe M, Nishimaki H, Kida M, Sunakawa K, Souma K, Saigenji K, Matsubara H, Yago K: Continuous regional arterial infusion therapy with biapenem and nafamostat mesilate for severe acute pancreatitis. J Jpn Pancreas Sci 2008, 23(5):578-586.
• [11]Kitahara Y, Nakamura M, Iwahashi M, Nakamori M, Ojima T, Yamaue H: A case of pseudomembranous enterocolitis caused by methicillin-resistant Staphylococcus aureus in the interposed ileum after esophagectomy. J Jpn Surg Assoc 2011, 72(10):2524-2529.
• [12]Shimizu T: A case of toxic shock syndrome(TSS) induced by MRSA in post operation period of gastric cancer. Niigata Igakkai Zasshi 2009, 123(4):181-187.
• [13]Hayashi T, Yoshizawa M, Watanabe N, Murayama Y: Two cases of toxic shock syndrome treated by blood purification therapy. J Jpn Sci Surg Infect 2006, 3(2):167-170.
• [14]Higuchi R, Ota T, Kajiyama H, Yazawa T, Uemura S, Sato T, Nakamura T, Yamamoto M: A case of surgical drainage in post coronary artery bypass grafting complicated with diffusing peritonitis and mediastinitis. J Abdom Emerg Med 2011, 31(3):561-565.
• [15]Higuchi T, Sato N, Otsuka K, Ito N, Kawasaki Y, Fujiwara H, Kashiwada T, Hayakawa Y, Asahi H, Saito K, Sato S: A case of MRSA enteritis with idiopathic perforation of the sigmoid colon. J Jpn Sci Surg Infect 2002, 14:45-50.
• [16]Yanagi Y, Kubota T, Matsui K, Kadokura Y, Hanaoka H: Enterocolitis caused by methicillin-resistant Staphylococcus aureus (MRSA) after bilateral neck dissection. Practica Otologica 2002, 95(4):409-412.
• [17]Mizumoto S, Hitani Y, Akashi H, Sasaki M, Kurokawa E, Yamamoto H, Okano K, Taniguchi H, Takami K, Umeshita K: A case of gallbladder cancer with duplication of common bile duct and anomalous junction of pancreaticobiliary duct. Jpn J Gastroenterol Surg 2003, 36(5):378-382.
• [18]Uchida E, Furukawa K, Matsushita A, Aimoto T, Nakamura Y, Katsuno A, Chou K, Tajiri T: The significance of intestine and bacterial translocation in severe acute pancreatitis. The Journal of the Japanese Society of Clinical Studies on Intestinal Microflora 2004, 1:17-21.
• [19]Hatakeyama J, Inomata H, Sato N: A case of MRSA enterocolitis occurred after ileus operation. J Jpn Coll Surg 2005, 30(6):882-884.
• [20]Hashimoto Y, Sakashita Y, Takamura M, Iwako H, Watanabe Y, Shigemoto N, Kin K: Massive rectroperitoneal emphysema caused by the stercoral perforation of the sigmoid colon. Jpn J Gastroenterol Surg 2005, 38(5):566-570.
• [21]Nishizawa K, Terasaka S, Hirai E, Kuga Y: A case of shock and DIC because of MRSA enteritis during the medical treatment of odontogenic infection. Kyūshū Shika Gakkai Zasshi 2005, 59(1):22-26.
• [22]Miyake T, Shimizu T, Sonoda H, Mekata E, Murata S, Tani T: A case of intestinal metastasis of lung cancer undedicated preoperative diagnosis. J Jpn Coll Surg 2011, 36(5):787-791.
• [23]Fujii Y, Takagi I: A case of pneumotosis cytoides intestinalis associated with MRSA enteritis. J Jpn Coll Surg 2010, 71(12):3158-3161.
• [24]Nakai Y, Nakata T, Sato H: A case of enterocolitis caused by methicillinresistant Staphylococcus aureus after coronary artery bypass grafting. J Clin Med Imabari Med Assoc 2007, 20(1):22-26.
• [25]Takesue Y, Yokoyama T, Kodama T, Santou T, Nakamitsu A, Murakami Y, Imamura Y, Miyamoto K, Okita M, Tsumura H: Toxin involvement in methicillin-resistant Staphylococcus aureus enteritis in gastroenterological surgery. Gastroenterol Jpn 1991, 26(6):716-720.
• [26]Kodama T, Santo T, Yokoyama T, Takesue Y, Hiyama E, Imamura Y, Murakami Y, Tsumura H, Shinbara K, Tatsumoto N, Matsuura Y: Postoperative enteritis caused by methicillin-resistant Staphylococcus aureus. Surg Today 1997, 27(9):816-825.
• [27]Gravet A, Rondeau M, Harf-Monteil C, Grunenberger F, Monteil H, Scheftel JM, Prevost G: Predominant Staphylococcus aureus isolated from antibiotic-associated diarrhea is clinically relevant and produces enterotoxin a and the bicomponent toxin LukE-lukD. J Clin Microbiol 1999, 37(12):4012-4019.
• [28]Casewell MW, Hill RL: The carrier state: methicillin-resistant Staphylococcus aureus. J Antimicrob Chemother 1986, 18(Suppl A):1-12.
• [29]Christie CD, Lynch-Ballard E, Andiman WA: Staphylococcal enterocolitis revisited: cytotoxic properties of Staphylococcus aureus from a neonate with enterocolitis. Pediatr Infect Dis J 1988, 7(11):791-795.
• [30]Komori Y: Epidemic Study of Nasal Carriage of Methicillin-Resistant Staphylococci (MRSA and MRC-NS) in the Volunteers without Apparent Infectious Disease. http://kaken.nii.ac.jp/d/p/14570308.ja.html webcite
• [31]Masaki H, Yoshimine H, Miyata K, Nakanishi T, Degawa S, Takahashi H, Kuroki R, Morimoto K, Kaida S, Matsumoto K: a clinical study of gastrointestinal flora in patients with, or without MRSA colonization in the upper-respiratory tract after introduction of preventive measures of hospital infection. Kansenshogaku Zasshi 1995, 69(11):1260-1268.
• [32]Froberg MK, Palavecino E, Dykoski R, Gerding DN, Peterson LR, Johnson S: Staphylococcus aureus and clostridium difficile cause distinct pseudomembranous intestinal diseases. Clin Infect Dis 2004, 39(5):747-750.
• [33]Watanabe H, Masaki H, Asoh N, Watanabe K, Oishi K, Kobayashi S, Sato A, Nagatake T: Enterocolitis caused by methicillin-resistant Staphylococcus aureus: molecular characterization of respiratory and digestive tract isolates. Microbiol Immunol 2001, 45(9):629-634.