A Case of Severe Methicillin Resistant Staphylococcus Aureus Enterocolitis

Toshiaki Iba, Tetsu Fukunaga, Kazuyoshi Sugiyama, Masaki Fukunaga, Akio Kidokoro, Yoshihiro Yagi

Department of Surgery, Juntendo University Urayasu Hospital

A case of methicillin-resistant staphylococcal (MRSA) enterocolitis following subtotal gastrectomy and colectomy is presented. MRSA enterocolitis is characterized clinically by high fever and frequent watery diarrhea. In this case, however, the patient had increased fluid discharge from the nasogastric tube beginning on the second postoperative day (POD), fell into shock on the fourth POD without typical diarrhea and failed to recover in response to conventional fluid therapy, infusion of dopamine and norepinephrine, antibiotic therapy and intensive care, including continuous hemofiltration and plasma exchange. The patients died on the tenth POD because of progression of renal failure, liver failure and DIC. Because it is sometimes difficult to diagnose MRSA associate with paralytic ileus in the postoperative state, it is important to be attemptive to fluid discharge from nasogastric tubes. If MRSA enterocolitis is suspected, because of its high mortality rate, even though typical diarrhea is not observed, appropriate treatment for MRSA should be promptly instituted before a bacteriological diagnosis is made.

Key words
methicillin-resistant staphylococcus aureus, staphylococcal enterocolitis, continuous hemofiltration

Reprint requests
Toshiaki Iba Department of Surgery, Juntendo University Urayasu Hospital
2-1-1 Tomioka, Urayasu, 279 JAPAN

Accepted
January 8, 1992

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