Infection and Drug Resistance (Jun 2024)
Epidemiological Study on Case Definition of Methicillin-Resistant Staphylococcus aureus Enteritis
Abstract
Yusuke Yagi,1,2 Akito Doke,1,3 Saya Iwame,1,3 Yu Arakawa,1,4 Yuka Yamagishi1,4 1Department of Infection Prevention and Control, Kochi Medical School Hospital, Nankoku, Kochi, Japan; 2Department of Pharmacy, Kochi Medical School Hospital, Nankoku, Kochi, Japan; 3Department of Clinical Laboratory, Kochi Medical School Hospital, Nankoku, Kochi, Japan; 4Department of Clinical Infectious Diseases, Kochi Medical School, Kochi University, Nankoku, Kochi, JapanCorrespondence: Yuka Yamagishi, Department of Clinical Infectious Diseases, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan, Tel +81 88 866 5811, Fax +81 88 880 2611, Email [email protected]: Methicillin-resistant Staphylococcus aureus (MRSA) enteritis is a condition in which MRSA grows abnormally in the intestine after administration of antimicrobial agents, resulting in enteritis. Patients with MRSA detected in stool culture tests are often diagnosed with MSRA enteritis. However, uncertainty remains in the diagnostic criteria; therefore, we conducted epidemiological studies to define these cases.Patients and Methods: Patients who tested positive for MRSA by stool culture using selective media 48 h after admission to Kochi Medical School Hospital between April 1, 2012, and December 31, 2022, and did not meet the exclusion criteria were included. We defined MRSA enteritis (Group A) as cases that were responsive to treatment with vancomycin hydrochloride powder, had a Bristol Stool Scale of ≥ 5, and a stool frequency of at least three times per day; all others were MRSA carriers (Group B). Multivariate analysis was performed to risk factors associated with MRSA enteritis.Results: Groups A and B included 18 (25.4%) and 53 (74.6%) patients, respectively. Multivariate logistic regression analysis showed that a white blood cell count of > 10000/μL (odds ratio [OR], 5.50; 95% confidence interval [CI], 1.12– 26.9), MRSA count of ≥ 2+ in stool cultures (OR, 8.91; 95% CI, 1.79– 44.3), and meropenem administration within 1 month of stool specimen submission (OR, 7.47; 95% CI, 1.66– 33.6) were risk factors of MRSA enteritis.Conclusion: The case definitions reviewed for MRSA enteritis may be useful as diagnostic criteria. Keywords: MRSA enteritis, diagnostic criteria, white blood cell, MRSA counts in stool cultures, meropenem
