Antibacterials
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Antibacterials Antibiotic-associated diarrhoea and methicillin-resistant Staphylococcus aureus enteritis: case report
A 34-year-old woman developed antibiotic-associated diarrhoea and methicillin-resistant Staphylococcus aureus (MRSA) enteritis during treatment with ampicillin/sulbactam, levofloxacin and meropenem for pneumonia [dosages and routes not stated]. The woman, who had severe dyspnoea, was transferred to emergency center due to pneumonia with pneumothorax. She did not have any relevant past medical history. She started receiving mechanical ventilation. Her hypoxia persisted; hence, she was intubated and chest tube was inserted. In the previous hospital, she had started receiving meropenem after levofloxacin due to severe pneumonia. She was found to have Streptococcus and Corynebacterium species in her sputum. On day 5 of admission, her treatment was changed from meropenem to ampicillin/sulbactam [sulbactam/ampicillin]. She showed improvement and was extubated on day 7. She also received concomitant diclofenac [diclofenac sodium]. However, from day 8, her body temperature increased to 40°C with erythema in all four limbs and severe watery diarrhoea for more than 10 times/day. Her WBC count increased to 22 800 /mm3 and serum C-reactive protein increased to 25 mg/dL. Her blood culture was negative. The detection kits for Clostridium difficile and Norovirus in stool samples were negative. Abdominal CT scan showed increased wall thickness of the small intestine and dilatation of the colon with fluid. A fecal Gram stain clearly revealed neutrophil phagocytosis of Gram-positive cocci in the microscopic field. Thus, MRSA enteritis and diarrhoea secondary to meropenem, levofloxacin and ampicillin/sulbactam was diagnosed [not all duration of treatments to reaction onsets not stated]. On day 9, vancomycin was started. The woman’s erythema resolved within 2 days and fever and diarrhoea decreased within 1 week, and the vancomycin was stopped on day 14. Subsequently, she was discharged. Fecal culture and laboratory tests showed MRSA. A detection kit for toxic shock syndrome toxin 1 (TSST-1) in bacterial culture supernatant from a stool specimen was positive. However, toxic shock syndrome was later ruled out. Multilocus sequence typing revealed the ST5 clone. The taxonomic composition of the fecal gut microbiota at the genus level as determined by the metagenomic 16S rRNA sequencing of her feces revealed that Prevotella (18.4%), Actinomyces (18.0%), and Streptococcus (17.2%) were the major genera present on day 9. The proportion of Staphylococcus was 4.4%, and C. difficile were not found. However, on day 31, Bacteroides and Enterococcus were the major bacteria. Shimizu K, et al. Fecal Gram staining of phagocytosed bacteria to differentiate methicillin-resistant Staphylococcus aureus: A case report. Journal of Infection and Chemotherapy 26: 1078-1081, No. 10, Oct 2020. Available from: URL: http://doi.org/10.1016/j.jiac.2020.05.021
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