Multiple intestinal ulcerations and perforations secondary to methicillin-resistant Staphylococcus aureus enteritis in infants

Purpose: The aim of this study was to define a distinctive clinical entity of multiple intestinal ulcerations and perforations in infants. Methods: Two infants underwent abdominal exploration for surgical abdomen a nd were noted to have multiple intestinal ulcerations and perforations. A p eculiar and unique surgical finding, numerous transverse linear ulcerations scattered along the entire small intestine, prompted us to search for simi lar instances. Five similar cases were additionally identified by members o f the Korean Association of Pediatric Surgeons. The clinical courses, the s urgical findings, and the results of bacterial cultures were reviewed. As w ell, the tissues of resected intestines were examined histopathologically. Results: The characteristics of this entity are as follows. (1) It usually occurs in infants who have been treated with broad-spectrum antibiotics. (2 ) Despite broad-spectrum antibiotic treatment, diarrhea and abdominal diste nsion developed progressively and deteriorated. (3) Histological evaluation showed mucosal ulcers with neutrophil infiltration, submucosal microabsces ses, and colonies of Gram-positive cocci. (4) Methicillin-resistant Staphyl ococcus aureus (MRSA) was the predominant organism cultured from the body f luid. (5) Only two cases, the completely resected one and the one immediate ly treated postoperatively with vancomycin, survived. Conclusions: This entity is caused by multiple intestinal ulcerations and p erforations secondary to MRSA enteritis in infants. It has a high mortality rate because of its difficult diagnosis. However, early recognition of thi s entity can lead to successful treatment. Copyright (C) 1999 by W.B. Saund ers Company.