Successful perioperative infection control measures after gastroenterological surgery reduced the number of cases of methicillin-resistant Staphylococcus aureus or Clostridioides (Clostridium) difficile infection to almost zero over a 30-year period: a single-department experience

• Published in: Surgery today (Tokyo, Japan) Vol. 50; no. 3; pp. 258 - 266
• Main Authors: Kusachi, Shinya, Watanabe, Manabu, Asai, Koji, Kiribayashi, Takaharu, Niitsuma, Toru, Nishimuta, Hironobu, Saida, Yoshihisa
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.03.2020
• Subjects: Medicine; Medicine & Public Health; Original Article; Surgery; Surgical Oncology; SSI; Post-operative infection; Tazobactam/piperacillin; MRSA; C. difficile
• DOI: 10.1007/s00595-019-01899-2
• ISSN: 0941-1291

Purpose To investigate changes in the incidence of postoperative infections in the surgical department of a teaching hospital. Methods During the 30-year period from September 1987 to August 2017, 11,568 gastroenterological surgical procedures were performed in our surgical department. This 30-year period was divided into seven periods (A–G), ranging from 2 to 7 years each and based on the infection control methods used in each period. We then compared the rates of incisional surgical site infection (SSI) and organ/space SSI; remote infection (RI) including respiratory tract infection (RTI), intravascular catheter-related infection, and urinary tract infection (UTI); and antibiotic-associated colitis caused by methicillin-resistant Staphylococcus aureus (MRSA) enteritis or Clostridioides (Clostridium) difficile -associated disease (CDAD) among the seven periods. Results In periods B (September 1990–August 1997) and E (November 2004–July 2007), when a unique antibiotic therapy devised in our department was in use, MRSA was isolated from only 0.3% and 0.4% of surgical patients, respectively, and these rates were significantly lower than those in the other periods ( p  < 0.05). The rate of CDAD increased during period F (August 2007–July 2014), but in period G (August 2014–August 2017), restrictions were placed on the use of antibiotics with a strong anti-anaerobic action and, in this period, the rate of CDAD was only 0.04%, which was significantly lower than that in period F ( p  < 0.05). Conclusions Limiting the use of antibiotics that tend to disrupt the intestinal flora may reduce the rates of MRSA infection and CDAD after gastroenterological surgery.