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Journal of Clinical Microbiology, December 1999, p. 4012-4019, Vol. 37, No. 12
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.

Predominant Staphylococcus aureus Isolated from Antibiotic-Associated Diarrhea Is Clinically Relevant and Produces Enterotoxin A and the Bicomponent Toxin LukE-LukD

Alain Gravet,1 Murielle Rondeau,2 Colette Harf-Monteil,1 Fabienne Grunenberger,3 Henri Monteil,1 Jean-Michel Scheftel,1 and Gilles Prévost1,*

UPRES EA-1318, Institut de Bactériologie de la Faculté de Médecine (Université Louis Pasteur-Hôpitaux Universitaires de Strasbourg),1 and Service de Médecine Interne, Clinique Médicale A,2 and Service de Médecine Interne, Hôpital de Hautepierre,3 Hôpitaux Universitaires de Strasbourg, F-67000 Strasbourg, France

Received 28 May 1999/Returned for modification 7 June 1999/Accepted 16 August 1999

Staphylococcus aureus was isolated as the predominant or only isolate from cultures of stools of 60 patients over 2 years in a university hospital, leading to the collection of 114 isolates. Diarrhea was observed in 90% of the patients. Ninety-eight percent of the patients had received antibiotics in the month before the diarrhea. Ninety-two percent of the S. aureus isolates were methicillin resistant. S. aureus was encountered with antibiotic-associated diarrhea among 47 quite elderly patients affected or not affected by a gastrointestinal disease. Among the antimicrobial treatments, cessation of the previous therapy when possible or rapid application of oral vancomycin therapy was the most appropriate. Analysis of total DNA by pulsed-field gel electrophoresis revealed 27 different SmaI pulsotypes distributed in 15 clusters. The pulsotypes never differed for related isolates from a single patient, even if they originated from patients with bacteremia. S. aureus was not isolated as the predominant isolate in cultures of stools of 57 patients who received an antimicrobial treatment for more than 5 days without diarrhea. Occurence of production of both enterotoxin A and the bicomponent leucotoxin LukE-LukD by the S. aureus isolates was significantly different from that by random isolates. The results strongly suggest that when predominant in stool samples, S. aureus should be considered a possible etiologic agent for some cases of antibiotic-associated diarrhea.

* Corresponding author. Mailing address: UPRES EA-1318, Institut de Bactériologie de la Faculté de Médecine (Université Louis Pasteur-Hôpitaux Universitaires de Strasbourg), 3 rue Koeberlé, F-67000 Strasbourg, France. Phone: (33) 3 88 21 19 70. Fax: (33) 3 88 25 11 13. E-mail: gilles.prevost{at}medecine.u-strasbg.fr.

Journal of Clinical Microbiology, December 1999, p. 4012-4019, Vol. 37, No. 12
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.


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