For his first digest of 1994 Professor Yoshio Mishima, Editor-in-Chief of Sugerv Today (The Japanese Journal ofsurgery), has selected from the October to December 1993 issues. A summary of BJSarticles for the same period appears in the March issue of the Japanese journal.
Infection
Shimada et ul.' investigated the characteristics, risk factors and prevention of methicillin-resistant Szuphylococcus aureus (MRSA) infection in 3627 patients. O f these, 1336 with various infections were used in a risk factor analysis to determine the relationship between the use of antibiotics and the incidence of MRSA infection. Only 3.0 per cent of all infections were attributed to MRSA, the oesophagus and colorectum being primarily involved (as anastomotic or pelvic abscess) whereas the lung carried a lower incidence. Almost half the patients with MRSA infection (48 per cent) had concomitant sepsis. Univariate analysis revealed the following factors to be significant: the coexistence of gastrointestinal or metastatic malignancy, sepsis or tracheostomy and previous use of antibiotics such as the b-lactam compounds or aminoglycosides. Multivariate analysis showed that gastrointestinal malignancy, sepsis and the previous use of aminoglycosides, tetracycline, macrolides and carbapenems were independently significant risk factors. To promote the education of doctors and nurses, regular in-service meetings on MRSA were held in the ward. Preventive approaches such as patient isolation, strategic placement of hand-washing equipment and the use of disposable gloves and contaminated waste bags have been initiated; the incidence of MRSA has decreased significantly as a result. To control MRSA the following steps should be taken: (1) constant and careful surveillance; (2) regular risk factor analysis; (3) optimal administration of antibiotics; and (4) education of all hospital staff.
A study was conducted to determine whether compromised host defence mechanisms before surgery are related to postoperative infection by MRSA'. Neutrophil cytocidal activity, serum complement and immunoglobulin levels, the in vivo antibody-producing capacity against pneumococcal polysaccharide and cell-mediated immunity were evaluated in 22 patients undergoing oesophagectomy for cancer between 1989 and 1990. After operation nine patients developed MRSA infection. The level of antipneumococcal polysaccharide immunoglobulin G was significantly lower in patients with MRSA infection than in those without (P<@Ol). All patients with MRSA infection showed a titre below 600 units, whereas all but one of the uninfected patients had a titre above this level. The degree of impairment of other components of defence mechanisms, apart from a partial deficiency of cell-mediated immunity, did not differ between the groups. Preoperative evaluation of antibody-producing capacity may predict the development of MRSA-related infection following major surgery such as oesophagectomy.