Clinical and pathological study of 34 patients with isolation of methicillin-resistant Staphylococcus aureus in stool culture

Abstract

Clinical and pathological findings of 34 patients with isolation of methicillin-resistant Staphylococcus aureus (MRSA) from stools during the past one and half a year were studied. Twenty-three patients (68%) had internal diseases and the remaining were postoperative patients (32%). Thirty-three patients (97%) had diarrhea, and properties of the stools were watery in twenty-four and mushy in nine. The degrees of fever, leukocytosis and increase of serum C-reactive protein as inflammatory signs were various, and these had no relation with severity of diarrhea. Diarrhea preceded MRSA infection of organs except for the digestive tract in 7 patients (21%) and appeared alone in 14 patients (41%). These results indicate that closed observation of the stool was very important for early diagnosis of MRSA enterocolitis. C. difficile were isolated in 17 patients (50%) and there were many patients whom C. difficile took part in diarrhea. We should take notice of this organism on stool culture and therapy of diarrhea. Twenty-seven patients (79%) improved and 7 patients (21%) died. Three patients who did had MRSA enterocolitis as one of the cause of death. This shows that early diagnosis and therapy are important and fundamental therapy are the attempt of improvement of the general condition and appropriate use of antibiotics. Pathologically most the common finding was edema of the colon, which was found in 4 of five autopsied patients, and specific findings were not observed. As other findings, edema and bleeding of ileum and multiple erosion of the colon were found in one, bleeding of the colon in one, and neutrophil infiltration and pseudomembrane of the colon in one with isolation of C. difficile.