New Methods of Control Against Postoperative Methicillin-Resistant Staphylococcus aureus Infection

Abstract

The incidence of postoperative infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in Japan has been increasing dramatically. In March 1990, we assigned special doctors in infection control (infection control doctor, ICD), and defined comprehensive controls against MRSA infection. A total of 3536 cases of digestive tract surgery performed at our department were studied during the period between September 1987 and August 1997. We changed the use of antibiotics to prevent postoperative infection. Cefazolin (CEZ) was employed for surgery of the upper digestive tract, including esophagus, stomach, duodenum, and gallbladder. Cefotiam (CTM) was employed for surgery of the lower digestive tract, liver, and pancreas. In esophageal resection, the tracheal tube was extracted during the early postoperative period, and for cervical esophagogastroanastomosis, the autosuture was changed to layer-to-layer anastomosis. We have achieved successful control of postoperative MRSA infection, the incidence having decreased to 0.3% (9/2703). In conclusion, our methods of control against postoperative MRSA infection implies that comprehensive measures of prevention, including the reviewed specification and usage of antibiotics and operation management, have been well implemented. This value is the lowest and the first of any domestic hospital or institute in Japan, suggesting a continued and significant decrease.

Impact of Oral Antimicrobial Prophylaxis on Surgical Site Infection and Methicillin-Resistant Staphylococcus aureus Infection After Elective Colorectal Surgery. Results of a Prospective Randomized Trial

“…13 Oral antimicrobial prophylaxis as long as 3 days had been performed until MRSA infections prevailed postoperatively in accordance with the widespread use of third-generation cephalosporins between the late 1980s and early 1990s. 5,14 Not a few Japanese surgeons thereafter began to consider that chemical bowel preparation, which may induce endogenous overgrowth of bacteria such as MRSA along with the use of third-generation cephalosporins, is not necessary and now prefer mechanical bowel cleansing alone. 4,5 However, in Japan renewed interest has recently been focused on useful regimens of oral antimicrobial prophylaxis using parenteral antibiotics other than third-generation cephalosporins.…”

“…5,14 Not a few Japanese surgeons thereafter began to consider that chemical bowel preparation, which may induce endogenous overgrowth of bacteria such as MRSA along with the use of third-generation cephalosporins, is not necessary and now prefer mechanical bowel cleansing alone. 4,5 However, in Japan renewed interest has recently been focused on useful regimens of oral antimicrobial prophylaxis using parenteral antibiotics other than third-generation cephalosporins. 6,15,16 In those trials, 6,15,16 the duration of preoperative oral antibiotics ranged from 1 to 3 days, which were concurrent with this study.…”

“…3 Despite innumerable arguments among Japanese surgeons, [4][5][6] there are still no convincing data demonstrating a causative relationship between the use of oral antimicrobial prophylaxis and the outbreak of MRSA following colorectal surgery. This prospective randomized trial was therefore performed to evaluate the effect of administering preoperative oral antibiotics on the incidence of surgical site infection and MRSA infection in patients undergoing elective colorectal surgery.…”

Questionnaire on Perioperative Antibiotic Therapy in 2003: Postoperative Prophylaxis

“…[1][2][3] However, the protocols for postoperative antibiotic therapy in Japan were revised after the outbreak of Methicillinresistant Staphylococcus aureus (MRSA) infections in the late 1980s. 4 At the 43rd Conference of the Japanese Society of Gastroenterological Surgery in 1994, a panel discussion called "On the usage methods of antibiotic agents in gastroenterological surgery" published the results of a questionnaire on the use of antibiotics in gastroenterological surgery in 1993. 5 The Japanese Association for Infectious Disease and the Japanese Society for Chemotherapy published an Antibiotic Guide 10 years later.…”

MRSA in the 21st Century: Emerging Challenges

“…Prior use of antibiotics‚ especially broad-spectrum or in multiple courses‚ is a major risk factor for MRSA acquisition. Moreover‚ reducing the duration and antimocrobial spectrum of surgical prophylaxis has been shown to reduce the rate of MRSA infections (Brady et al‚ 1990;Fukatsu et al‚ 1997;Kusachi et al‚ 1999). Therefore‚ the results of rational and justified use of antibiotics should be beneficial in the long term.…”