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[Clinical study on postoperative infections caused by methicillin-resistant Staphylococcus aureus after
Y Hanatani1, T Hasumi, T Asagoe
1First Department of Surgery, School of Medicine, Teikyo University.
Abstract:
We studied 308 postoperative infections (216 patients) after gastrointestinal surgery during 1987-1991, to elucidate the incidence of postoperative infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and its correlation to clinical background factors. Results were as follows: (1) MRSAs were isolated from 25.9% out of 216 patients or 22.4% out of 308 infections. (2) The isolation rate of MRSA was significantly high in infectious enterocolitis (64.7%, p < 0.001), intraabdominal infections (52.5%, p < 0.001) and respiratory tract infections (35.3%, p < 0.05). On the other hand, it was significantly low in bacteremias (9.28%, p < 0.001), wound infections (13.6%, p < 0.05) and urinary tract infections (3.33%, p < 0.05). (3) MRSAs were found more frequently in male (p < 0.05), younger patients (p < 0.05) and patients with malignant disease (p < 0.10). Whereas no difference was recognized between patients with or without complication. (4) The isolation rate of MRSA by the kind of antibiotics used after surgery, was 0% (0/20, the 1st generation cephems), 17.2% (10/58, the 2nd generation cephems) and 54.5% (48/88, the 3rd generation cephems). Significant differences were found among each group (p < 0.05, p < 0.001). (5) During 1990-1991 when the 1st generation cephems were used frequently, MRSAs were found significantly lower in frequency than during 1987-1989 (p < 0.05). Especially a marked decrease in the rate of MRSA (51.4% to 8.33%, p < 0.05) was seen among patients after upper gastrointestinal surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) caused 25.9% of postoperative infections after gastrointestinal surgery. Using first-generation cephems significantly reduced MRSA rates, especially in upper gastrointestinal surgeries.
Area of Science:
- Infectious Diseases
- Surgical Infections
- Antimicrobial Resistance
Context:
- Postoperative infections following gastrointestinal surgery pose a significant clinical challenge.
- Methicillin-resistant Staphylococcus aureus (MRSA) is a notable pathogen in healthcare-associated infections.
- Understanding the epidemiology of MRSA in surgical settings is crucial for effective treatment and prevention strategies.
Purpose:
- To determine the incidence of MRSA in postoperative infections after gastrointestinal surgery.
- To correlate MRSA isolation rates with clinical background factors and antibiotic usage.
- To evaluate the impact of antibiotic choice on MRSA prevalence.
Summary:
- MRSA was isolated in 25.9% of patients and 22.4% of infections. High rates were observed in enterocolitis, intraabdominal, and respiratory infections, while lower rates were seen in bacteremia, wound, and urinary tract infections.
- MRSA was more frequent in male, younger patients, and those with malignant disease. Antibiotic choice significantly impacted MRSA isolation rates, with third-generation cephems associated with higher rates than first-generation cephems.
- A shift towards first-generation cephem use in 1990-1991 correlated with a significant decrease in MRSA frequency, particularly after upper gastrointestinal surgery.
Impact:
- Findings highlight the significant burden of MRSA in gastrointestinal surgical infections.
- The study demonstrates a clear link between antibiotic selection and MRSA prevalence, suggesting a potential strategy for control.
- Results underscore the importance of antimicrobial stewardship and targeted antibiotic use to combat MRSA in surgical patients.