Gururangan Kapil, Holubar Marisa K
Department of Internal Medicine, Kaiser Permanente Medical Center, Santa Clara, CA, USA.
Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Am J Case Rep. 2020 Sep 29;21:e922521. doi: 10.12659/AJCR.922521.
BACKGROUND Nosocomial diarrhea affects 12% to 32% of hospitalized patients. Before the development of the Clostridium difficile cytotoxin assay in the 1970s, Staphylococcus aureus was frequently implicated as a cause of hospital-acquired infectious colitis, particularly in association with recent antibiotic therapy or abdominal surgery. Decreased utilization of stool culture has reduced the recognition of S. aureus as a rare, but historically important, cause of enterocolitis. CASE REPORT An 81-year-old man with no recent history of travel, exposure to potential infectious sources (e.g., sick contacts, animals, undercooked foods), or antibiotic or proton-pump inhibitor use was admitted for a Whipple procedure (expanded intraoperatively with total pancreatectomy, splenectomy, and portal vein resection) for stage III pancreatic adenocarcinoma. On postoperative day (POD) 5, the patient developed large-volume watery diarrhea that did not improve with tube feeding cessation and oral pancreatic enzyme replacement. He subsequently became clinically septic on POD10, and workup revealed severe radiographic sigmoid and rectal colitis and methicillin-resistant S. aureus (MRSA) bacteremia. Polymerase chain reaction testing for C. difficile was negative twice (POD5 and POD12). He was diagnosed with MRSA proctocolitis and improved with initiation of oral and intravenous vancomycin. CONCLUSIONS We describe a case of staphylococcal enterocolitis, a previously common cause of nosocomial diarrhea that has become increasingly underappreciated since the advent of culture-independent stool testing for C. difficile. Increased awareness of this entity, especially when Clostridium assays are negative, may guide more effective treatment of hospital-acquired infection.
背景 医院获得性腹泻影响12%至32%的住院患者。在20世纪70年代艰难梭菌细胞毒素检测方法出现之前，金黄色葡萄球菌常被认为是医院获得性感染性结肠炎的病因，尤其是与近期抗生素治疗或腹部手术相关时。粪便培养的使用减少，降低了对金黄色葡萄球菌作为一种罕见但历史上重要的小肠结肠炎病因的认识。病例报告 一名81岁男性，近期无旅行史、无接触潜在传染源（如患病接触者、动物、未煮熟食物）史，也未使用过抗生素或质子泵抑制剂，因III期胰腺腺癌接受惠普尔手术（术中扩大为全胰切除术、脾切除术和门静脉切除术）入院。术后第5天（POD5），患者出现大量水样腹泻，停止管饲和口服胰酶替代治疗后仍未改善。随后在POD10时出现临床脓毒症，检查发现严重的乙状结肠和直肠结肠炎影像学表现以及耐甲氧西林金黄色葡萄球菌（MRSA）菌血症。艰难梭菌的聚合酶链反应检测两次均为阴性（POD5和POD12）。他被诊断为MRSA直肠结肠炎，开始口服和静脉注射万古霉素后病情好转。结论 我们描述了一例葡萄球菌小肠结肠炎病例，这是一种曾是医院获得性腹泻常见病因的疾病，自出现针对艰难梭菌的非培养粪便检测方法以来，其受到的关注越来越少。提高对该疾病的认识，尤其是在艰难梭菌检测为阴性时，可能会指导对医院获得性感染更有效的治疗。
