Inamatsu T, Ooshima H, Masuda Y, Fukayama M, Adachi K, Takeshima H, Hashimoto H
Tokyo Metropolitan Geriatric Hospital.
Nihon Rinsho. 1992 May;50(5):1087-92.
Historically, various types of antibiotic-associated diarrhea have been recognized. In the 1950-1960s, multi-resistant Staphylococcus aureus was implicated to be major cause of antibiotic-associated diarrhea, especially pseudomembranous enterocolitis. In the late 1970s, a new type of antibiotic-associated diarrhea, which is characterized by pseudomembranous colitis and lack of fecal multi-resistant S. aureus, usually following lincosamide administration, was recognized. Many studies have revealed the pathogenic roles of Clostridium difficile in these patients. Recent emergence of methicillin resistant S. aureus (MRSA) provokes another type of antibiotic-associated diarrhea. We have tried to isolate S. aureus and C. difficile from 150 faecal samples of patients with antibiotic-associated diarrhea. S. aureus alone was isolated from 32 (21.3%) samples. C. difficile alone was isolated from 51 (34.0%) samples, and, both were detected in 23 (15.3%) samples. 90.9% of S. aureus were MRSA. Comparing the clinical features of these cases, patients with both C. difficile and MRSA showed more serious clinical features. The patients who had undergone laparotomy were accompanied by shock and meteorism, more often than patients without laparotomy. The management of antibiotic-associated diarrhea due to MRSA is discussed.
从历史上看，人们已经认识到多种类型的抗生素相关性腹泻。在20世纪50 - 60年代，多重耐药金黄色葡萄球菌被认为是抗生素相关性腹泻的主要原因，尤其是伪膜性小肠结肠炎。在20世纪70年代后期，一种新型的抗生素相关性腹泻被识别出来，其特征为伪膜性结肠炎且粪便中缺乏多重耐药金黄色葡萄球菌，通常发生在使用林可酰胺类药物之后。许多研究揭示了艰难梭菌在这些患者中的致病作用。耐甲氧西林金黄色葡萄球菌（MRSA）的近期出现引发了另一种类型的抗生素相关性腹泻。我们试图从150例抗生素相关性腹泻患者的粪便样本中分离金黄色葡萄球菌和艰难梭菌。仅从32份（21.3%）样本中分离出金黄色葡萄球菌。仅从51份（34.0%）样本中分离出艰难梭菌，并且在23份（15.3%）样本中同时检测到两者。90.9%的金黄色葡萄球菌为MRSA。比较这些病例的临床特征，同时感染艰难梭菌和MRSA的患者表现出更严重的临床特征。接受剖腹手术的患者比未接受剖腹手术者更常伴有休克和气胀。本文讨论了由MRSA引起的抗生素相关性腹泻的治疗。
