Clinical Study of Multiple Intestinal Ulcerations and Perforations Caused by Methicillin-Resistant Staphylococcus aureus in Infants

ABSTRACT

PURPOSE: In recent years, the authors experienced a distinctive clinical entity of multiple intestinal ulcerations and perforations in infants. The purpose of this study was to describe the clinical characteristics of this entity, examine th possible pathogenesis and the effective treatment. METHODS: Seven infants underwent abdominal exploration under suspicion of surgical abdomen and were noted to have multiple intestinal ulcerations and perforations without evidence of necrotizing enterocolitis by the members of the Korean Association of Pediatric Surgeons. The clinical courses, operative findings, bacterial cultures, pathologic findings, treatment and prognosis of these seven cases were evaluated retrospectively. RESULTS: The characteristics of this entity are as follows : The initial presenting symptoms were all different. Despite conservative treatment with a broad spectrum of antibiotics, diarrhea and abdominal distention developed and progressively grew worse. At laparotomy, all patients exhibited numerous typical transverse linear ulcerative lesions with pin-point perforations scattered mainly in the small bowel. Histologic evaluations of the resected specimens revealed mucosal ulcerations with neutrophil infiltration, submucosal microabscesses and colonies of gram-positive cocci. Methicillin-resistant Staphylococcus aureus(MRSA) was the predominant organism cultured from the body fluid. Only two cases, the completely-resected one and the one immediately treated with vancomycin after operation, survived. CONCLUSION: We think this distinct clinical entity exhibiting multiple intestinal ulcerations and perforations is caused by MRSA occurring in infants. It has a high mortality because it is verydifficult to diagnosis in young infants before laparotomy. Vancomycin is highly effective in treating MRSA, so we think the early diagnosis of this entity can make the treatment successful.