Influences of type and duration of antimicrobial prophylaxis on an outbreak of methicillin-resistant Staphylococcus aureus and on the incidence of wound infection
K. Fukatsu, H. Saito, T. Matsuda, S. Ikeda, S. Furukawa and T. Muto
First Department of Surgery, University of Tokyo, Japan. FUKATSU-1SU@h.u-tokyo.ac.jp
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.