The Prevention of Postoperative Respiratory Tract Infection and Methicillin-Resistant Staphylococcus Aureus (MRSA) lnfections for the Patients with Esophageal Resection

Shinya Kusachi, Yoshinobu Sumiyama, Sadahito Usui, Masumi Kurashige, Jiro Nagao, Minoru Kurita, Masatake Suzuki, Kunihiko Kawai, Youichi Arima

The Third Department of Surgery, Toho University School of Medicine

Postoperative MRSA infection after esophageal resection was studied with regard to the management of fluid infusion, anastomotic technique and antibiotic prophylaxis with cefazolin (CEZ). In group A (without management), the patients were administrated the ringer lactate at 642±69 ml/h, developed pulmonary edema due to hypoalubuminemia (2.6±0.2 g/dl) and needed controlled respiration postoperatively. This caused respiratory tract infection in 17.4% of the cases, and the incidence of MRSA infection was 8.7%. In group B (with management), perioperative infusion of ringer lactate was diminished to 72.4±6.9 ml/h, fresh frozen plasma was administrated at 1.5±2.0 ml/h/kg, and serum alubumine was maintained at 2.8±0.1 g/dl. Since the average term of controlled respiration was shortened from 38.7 hours in group A to 4.9 hours in group B, nosocominal infection was prevented. And cervical abscess caused by anastomotic leakage was not developed in group B. Although second or third generation cefem of antibiotics and aminoglycosides were given to group A patients for plopylaxis, cefazolin, a first generation cefem of antibiotic, was administrated in group B, to prevent MRSA infection. The incidence of postoperative MRSA infection was 8.9% in group A, and 0% in group B. There was a significant difference between the two groups. It seemed that fluid restoration with fresh frozen palsma stabilized the circulation, shortened the duration of controlled respiration and diminished respiratory tract secretions. This prevented MRSA contamination. The administration of cefazolin inhibited the colonization of MRSA. We conclude that not only management for nosocomial infection but also fluid restoration and selection of antibiotics for postoperative prophylactic use are needed for the management of postoperative MRSA infection in patients with esophageal resection.

Key words
postoperative MRSA infection, prevention of respiratory tract infection after esophageal resection, Cefazolin

Reprint requests
Shinya Kusachi The Third Department of Surgery, Toho Ohashi Hospital
2-17-6, Meguro-ku, Tokyo, 153 JAPAN

Accepted
September 8, 1993

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