Staphylococcus pseudomembranous enterocolitis, a complication of antibiotic therapy

I N the past live years the medical profession has become aware of the increasing incidence of cases of pseudomembranous or diphtheritic enterocoIitis found at necropsy. It has been suggested that the increase of the incidence of these cases runs parallel with the universal use of antibiotic drugs. Surgeons throughout this country and abroad are especially concerned with the frequent reports of this condition as a fatal complication in postoperative cases. In many of these patients bacterioIogic studies show that antibiotic-resistant StaphyIococcus aureus exists in pure culture in the feces and the intestinal Iesions and is considered the main etioIogic factor in the fata outcome. It is generaIIy accepted that a resistant staphyIococcus has developed as a result of antibiotic therapy in recent years. This staphylococcus is present in the nose, throat, skin and feces of many peopIe, both patients and hospita1 personne1. It is usuaIIy found in smaI1 numbers and causes no troubIe. However, in rare cases in which the norma bacteria1 Aora of the gastrointestina1 tract are destroyed or depressed by antibiotic therapy, this staphyIococcus grows rapidIy in Iarge numbers and produces the overwhelming infec-tion found in pseudomembranous enterocoIitis. Pseudomembranous or diphtheritic enterocolitis has been observed by pathoIogists at autopsy for many years. However, they have not been abIe to ascribe to it any clinics1 significance. In r8g3 Finneyr reported a case of bIoody diarrhea occurring ten days after a gastric operation. The patient died five days Iater and autopsy showed diphtheritic enteritis of the termina1 ileum and colon. No enteric pathogens were found. In 1902 Riedelr described five cases in which anatomic diphtheritic lesion of the intestine was found. These patients were al1 postoperative and died with a cIinica1 picture of diarrhea and circuIatory coIlapse within four or five days from the onset of their symotoms. He believed that the protracted operation, loss of blood, anesthesia, preoperative weakness and anemia united to make the intestine unabIe to resist its own contents. This diphtheria of the intestine, he said, was nothing more than a superhcial necrosis of a poorIy nourished mucosa. In 1910 N’ertheim’ mentioned diphtheritic enteritis in three patients in a series of 500 cases of radical pelvic exenteresis for carcinoma of the cervix. In 1920 Goldschmidt ant1 Mulederl noted thirty cases of diarrhea in 500 gastric operations. They described three typica cases of postoperative diarrhea, collapse and death with an anatomic diphtheritic Iesion in the lower ileum and colon. They found no pathogens in the stoo1. Penner and Bernheim? surveyed the records of the Mount Sinai HospitaI from 1929 to 1939 and found forty cases in which necropsy showed pseudodiphtheritic uIceronecrotic enteritis, coIitis or enterocoIitis. CompIete data were avaiIabIe in twenty instances. They were a11 postoperative patients of various kinds. The cIinica1 picture of postoperative diarrhea and coIIapse and the anatomic diphtheritic Iesion of the intestines were present in their typica * Clinical Associate in Surgery, Massachusetts General HospitaI, Boston, Mass.