Fundamental and clinical studies on postoperative methicillin-resistant Staphylococcus aureus (MRSA) enterocolitis

• Published in: CHEMOTHERAPY Vol. 40; no. 8; pp. 1049 - 1056
• Main Author: Suzui, Katsuya
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of Chemotherapy 1992
• ISSN: 0009-3165; 1884-5894
• DOI: 10.11250/chemotherapy1953.40.1049

Reports of postoperative MRSA enterocolitis have recently become common in Japan. This condition often occurs after gastric resection, and a relationship between MRSA enterocolitis and the operation is suggested by lowered acidity of the gastric juice. In this respect, reports on the relationship between H2-receptor antagonists and MRSA enterocolitis are similar. Needless to say, even when MRSA is isolated from gastric juice, many patients show no symptoms of enterocolitis. However, once symptoms appear, enterocolitis is taken for granted, as are wound infections, pneumonia and other diseases that occur as hospital-acquired infections. Hence, MRSA enterocolitis may develop because MRSA produces a strong enterotoxin. In Japan, MRSA producing enterotoxin-C and TSST (Toxic Shock Syndrome Toxin)-1 are known to occur frequently in enterocolitis. In this study, we examined nasal mucus and gastric juice before, during and after gastric surgery. We also conducted a few experiments on the Staphylococcus aureus isolated. Some patients already had MRSA in their nasal mucus at the time of their hospitalization, while others acquired MRSA in the hospital before surgerg. In cases when gastric juice pH increased after subtotal gastric resection, S. aureus Including MRSA tended to be isolated with greater frequency.This tendency was confirmed by our in vitro and animal studies. We assumed that intragastric MRSA would decrease but that the microorganism would proliferate in the lower digestive tract. However, MRSA enterocolitis did not occur during our study. These findings suggest that various factors, such as the use of antibiotics, the production of enterotoxin and TSST, and immunological factors, may be involved in the development of MRSA enterocolitis.