Open Access Highly Accessed Research article

A systematic review for pursuing the presence of antibiotic associated enterocolitis caused by methicillin resistant Staphylococcus aureus

Kentaro Iwata1*, Asako Doi2, Takahiko Fukuchi1, Goh Ohji1, Yuko Shirota3, Tetsuya Sakai4 and Hiroki Kagawa5

Author Affiliations

1 Division of Infectious Disease, Kobe University Hospital, 7-5-2 Kusunokicho, Chuoku, 650-0017 Kobe, Hyogo, Japan

2 Division of Infectious Diseases, Kobe City Medical Center General Hospital, 2-1-1 Minamicho, Mintojima, Chuoku, 650-0047 Kobe, Hyogo, Japan

3 Department of Pediatrics, Himeji Red Cross Hospital, 1-12-1 Shimoteno, 670-0063 Himeji, Hyogo, Japan

4 Department of Radiology, Kobe University Hospital, 7-5-2 Kusunokicho, Chuoku, 650-0017 Kobe, Hyogo, Japan

5 Division of Infectious Diseases, Shinko Hospital, 1-4-47 Wakihamacho, Chuoku, 651-0072 Kobe, Hyogo, Japan

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BMC Infectious Diseases 2014, 14:247  doi:10.1186/1471-2334-14-247

Published: 9 May 2014



Although it has received a degree of notoriety as a cause for antibiotic-associated enterocolitis (AAE), the role of methicillin resistant Staphylococcus aureus (MRSA) in the pathogenesis of this disease remains enigmatic despite a multitude of efforts, and previous studies have failed to conclude whether MRSA can cause AAE. Numerous cases of AAE caused by MRSA have been reported from Japan; however, due to the fact that these reports were written in the Japanese language and a good portion lacked scientific rigor, many of these reports went unnoticed.


We conducted a systematic review of pertinent literatures to verify the existence of AAE caused by MRSA. We modified and applied methods in common use today and used a total of 9 criteria to prove the existence of AAE caused by Klebsiella oxytoca. MEDLINE/Pubmed, Excerpta Medica Database (EMBASE), the Cochrane Database of Systematic Reviews, and the Japan Medical Abstract Society database were searched for studies published prior to March 2013.


A total of 1,999 articles were retrieved for evaluation. Forty-five case reports/series and 9 basic studies were reviewed in detail. We successfully identified articles reporting AAE with pathological and microscopic findings supporting MRSA as the etiological agent. We also found comparative studies involving the use of healthy subjects, and studies detecting probable toxins. In addition, we found animal models in which enteritis was induced by introducing MRSA from patients. Although we were unable to identify a single study that encompasses all of the defined criteria, we were able to fulfill all 9 elements of the criteria by collectively analyzing multiple studies.


AAE caused by MRSA—although likely to be rarer than previous Japanese literatures have suggested—most likely does exist.

Methicillin-resistant Staphylococcus aureus; MRSA; Enterocolitis; Pseudomembranous colitis; Clostridium difficile