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Kazuhiko Fukatsu, MD; Hideaki Saito, MD; Takeaki Matsuda, MD; Shigeo Ikeda, MD; Satoshi Furukawa, MD; Tetsuichiro Muto, MD

Arch Surg. 1997;132(12):1320-1325.

Abstract
Objective
To clarify how antibiotic prophylaxis influenced an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) and postoperative infection.

Design
Retrospective review.

Setting
University-affiliated teaching hospital.

Patients
All patients (n = 1824) undergoing subtotal esophagectomy, gastrectomy, or colorectal surgery during the period 1982 through 1995.

Main Outcome Measures
Type, timing, and duration of prophylactic antibiotics. Postoperative infection by the Centers for Disease Control and Prevention definition and the organisms isolated.

Results
Third-generation cephalosporins were frequently administered for prophylaxis during the period 1982 through 1990. The rate of isolates of MRSA from the infected site increased, peaking in 1988 to 1990. Since 1991 to 1992, along with a marked decrease in third-generation cephalosporin use, the rates of MRSA isolated have declined dramatically. The timing of administration changed from postoperative to intraoperative. Although the duration was gradually decreased, coverage was still provided until about the fifth postoperative day, even during 1993 to 1995. Prolonged coverage did not reduce the rate of superficial incisional or organ/space surgical site infection or that of pneumonia.

Conclusions
Overuse of third-generation cephalosporins for long periods caused an MRSA outbreak. Long-term prophylaxis did not lower infection rates. The briefest possible prophylaxis with first- or second-generation cephalosporins should be used in general surgery.

Arch Surg. 1997;132:1320-1325

Author Affiliations
From the First Department of Surgery (Drs Fukatsu, Matsuda, Ikeda, Furukawa, and Muto) and Surgical Center (Dr Saito), University of Tokyo, Tokyo, Japan.

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