title: A systematic review for pursuing the presence of antibiotic associated enterocolitis caused by methicillin resistant Staphylococcus aureus.
abstract: BACKGROUND
  Although it has received a degree of notoriety as a cause for antibiotic-associated enterocolitis (AAE), the role of methicillin resistant Staphylococcus aureus (MRSA) in the pathogenesis of this disease remains enigmatic despite a multitude of efforts, and previous studies have failed to conclude whether MRSA can cause AAE. Numerous cases of AAE caused by MRSA have been reported from Japan; however, due to the fact that these reports were written in the Japanese language and a good portion lacked scientific rigor, many of these reports went unnoticed.
  
  
  METHODS
  We conducted a systematic review of pertinent literatures to verify the existence of AAE caused by MRSA. We modified and applied methods in common use today and used a total of 9 criteria to prove the existence of AAE caused by Klebsiella oxytoca. MEDLINE/Pubmed, Excerpta Medica Database (EMBASE), the Cochrane Database of Systematic Reviews, and the Japan Medical Abstract Society database were searched for studies published prior to March 2013.
  
  
  RESULTS
  A total of 1,999 articles were retrieved for evaluation. Forty-five case reports/series and 9 basic studies were reviewed in detail. We successfully identified articles reporting AAE with pathological and microscopic findings supporting MRSA as the etiological agent. We also found comparative studies involving the use of healthy subjects, and studies detecting probable toxins. In addition, we found animal models in which enteritis was induced by introducing MRSA from patients. Although we were unable to identify a single study that encompasses all of the defined criteria, we were able to fulfill all 9 elements of the criteria by collectively analyzing multiple studies.
  
  
  CONCLUSIONS
  AAE caused by MRSA-although likely to be rarer than previous Japanese literatures have suggested-most likely does exist.
authors.affiliation: Division of Infectious Disease, Kobe University Hospital, 7-5-2 Kusunokicho, Chuoku, 650-0017 Kobe, Hyogo, Japan. kiwata@med.kobe-u.ac.jp.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Iwata
authors.forename: Asako
authors.initials: A
authors.lastname: Doi
authors.forename: Takahiko
authors.initials: T
authors.lastname: Fukuchi
authors.forename: Goh
authors.initials: G
authors.lastname: Ohji
authors.forename: Yuko
authors.initials: Y
authors.lastname: Shirota
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Sakai
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kagawa
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D004761:Enterocolitis, Pseudomembranous / Q000139:chemically induced / Q000382:microbiology*; D006801:Humans; D008712:Methicillin; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus; D013203:Staphylococcal Infections / Q000139:chemically induced / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D008712:Methicillin