Postoperative enteritis caused by methicillin-resistant Staphylococcus aureus.
We examined the clinical features of 14 men (mean age 72 years) with postoperative enteritis caused by methicillin-resistant Staphylococcus aureus (MRSA). The patients had all undergone surgery for the treatment of digestive diseases and had received antibiotic prophylaxis consisting of an extended-spectrum cephem. Diarrhea appeared a mean of 3.3 days postoperatively and lasted for 5 days on average. In severe cases organ insufficiency was involved. Coagulate-positive staphylococci were the predominant organisms isolated from watery diarrhea. In 13 of 14 patients, coagulase type II isolates producing enterotoxins A, C and toxic shock syndrome toxin-1 (TSST-1) with enterotoxin A, C, and 1st genes were isolated. These strains were sensitive to vancomycin and arbekacin; however, they were highly resistant to many other antibiotics. We also investigated the effects of a glucocorticoid hormone and gamma globulin on production of tumor necrosis factor-alpha (TNF-alpha) and interleukin-2 (IL-2) obtained from healthy volunteers. TNF-alpha and IL-2 production was enhanced by TSST-1 and the supernatant of Iscove-modified dulbecco medium, in which coagulase type II isolates producing enterotoxins A, C and TSST-1 with enterotoxin A, C were cultured for 24 h. Both glucocorticoid hormone and gamma globulin suppressed TNF-alpha and IL-2 production, thus suggesting that these drugs may be effective in treating postoperative MRSA enteritis.
Kodama
T
T
First Department of Surgery, Hiroshima University School of Medicine, Japan.
Santo
T
T
Yokoyama
T
T
Takesue
Y
Y
Hiyama
E
E
Imamura
Y
Y
Murakami
Y
Y
Tsumura
H
H
Shinbara
K
K
Tatsumoto
N
N
Matsuura
Y
Y
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D003982:Dibekacin / Q000031:analogs & derivatives / Q000494:pharmacology; D004066:Digestive System Diseases / Q000601:surgery; D004751:Enteritis / Q000276:immunology / Q000382:microbiology* / Q000628:therapy; D004768:Enterotoxins / Q000096:biosynthesis; D005938:Glucocorticoids / Q000494:pharmacology; D006801:Humans; D007074:Immunoglobulin G / Q000494:pharmacology; D066298:In Vitro Techniques; D007376:Interleukin-2 / Q000008:administration & dosage / Q000096:biosynthesis; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D011183:Postoperative Complications; D012772:Shock, Septic; D013203:Staphylococcal Infections; D013211:Staphylococcus aureus / Q000187:drug effects*; D014409:Tumor Necrosis Factor-alpha / Q000008:administration & dosage / Q000096:biosynthesis; D014640:Vancomycin / Q000494:pharmacology
D000900:Anti-Bacterial Agents; D004768:Enterotoxins; D005938:Glucocorticoids; D007074:Immunoglobulin G; D007376:Interleukin-2; D014409:Tumor Necrosis Factor-alpha; D003982:Dibekacin; D014640:Vancomycin