Letale Staphylokokken-Enterokolitis nach Achromycin

Zusammenfassung

Es werden 5 Kranke mit einer letalen hämorrhagisch-pseudomembranösen Enterokolitis nach einer Behandlung mit Achromycin beschrieben. Der tödliche Ausgang erfolgte 3mal an der Staphylokokkenenteritis, einmal an einer Proteus-Cholangitis und einmal an einer Pilzsepsis, verbunden mit einer Staphylokokkenpneumonie. Tetracyclin-resistente Staphylokokken fanden sich im Durchfallstuhl in 3 von 4 bakteriologisch untersuchten Fällen, sowie dreimal Bac. Proteus. Bei der Autopsie war neben der schweren Enterokolitis in einem Fall eine Pilzsepsis mit Geotrichum nachzuweisen. Genese Prophylaxe und Therapie dieser schweren Komplikation der Therapie mit Antibiotika werden besprochen.

Summary

Fatal haemorrhagic, pseudomembranous enterocolitis after the use of Achromycin occurred in five cases among 100 treated with the drug. (A total of 18% had diarrhoea.) The clinical picture was similar in all cases. There was acute diarrhoea with marked temperature rise, vague abdominal symptoms and lack of appetite. A few days later, profuse almost odourless defaecation quickly led to general deterioration ending in shock-like state, stupor and circulatory collapse. In two cases there was extreme hypopotassaemia. If the process was not combated early or the drug continued, the ultimately fatal outcome could not be prevented. The cause of death (proved by autopsy) was staphylococcal ulcerative, necrotizing enterocolitis in three cases, combined with bilateral pneumonia in two instances. In one case widely disseminated mycosis occurred, while B. proteus cholangitis caused death in the fifth case. It is thought that lowering of resistance caused by the infection for which Achromycin had been given contributed importantly to the fatal ending. Size of dose and its duration are important, but not alone decisive. (Four of the patients had received a total of 5—10 Gm.; one had received 16 Gm. Duration of treatment had been 4, 10, 10, 11, 11 days, respectively.) In one case enteritis resulted even after parenteral administration. Treatment of the enterocolitis should be symptomatic and supportive. Anti-staphylococcal antibiotics, such as Erythromycin and Magnamycin, should be tried, but resistant staphylococcal strains are common. Prophylaxis is best achieved by the restriction in the use of antibiotics. Broad-spectrum antibiotics should be given only when necessary and then for short, 3—4 day, periods. Stool examinations for resistant staphylococcal strains are recommended when antibiotics are given, and such drugs should be at once discontinued when diarrhoea occurs.

Resumen

Enterocolitis estafilocóccica mortal tras la administración de Acromicina

Los autores describen 5 enfermos con una grave enterocolitis hemorrágico-pseudomembranosa que se presentó tras un tratamiento con acromicina; 3 de los pacientes murieron de enterocolitis estafilocóccica, uno de colangitis por Proteus y uno de una sepsis por hongos. Se encontraron estafilococos acromicin-resistentes en las deposiciones diarreicas de tres casos explorados bacteriológicamente y en tres casos se pudo demostrar Bac. proteus. En la autopsia pudo evidenciarse, junto a una grave enterocolitis en uno de los casos, una sepsis por hongos del género Geotrichum. Los autores hacen referencia a la génesis, profilaxis y tratamiento de esta grave complicación de la terapéutica con antibióticos.