Postoperative infection with methicillin-resistant Staphylococcus aureus and its control measures in patients with esophageal cancer--prediction of high risk patients]

Whether or not compromised host defense prior to surgical treatment is related to development of infection with methicillin-resistant staphylococcus aureus (MRSA) following major surgery was examined. Of 22 patients undergoing esophagectomy for cancer between 1989 and 1990, 5 were free from MRSA colonization and infection (group I) while 8 had MRSA colonization without infection (group II) and 9 had MRSA infection (group III). Levels of neutrophil cytocidal functions, complements, immunoglobulins and cell-mediated immunity were not significantly different among these three groups. The mean of anti pneumococcal polysaccharide (PPS)-IgG was significantly lower in group III than in group I (p < 0.05) and tended to be lower than in group II (P = 0.08). All infected patients showed a titer < 600 EU while all but one non-infected patient did so > 600 EU. Serum IgG2 levels positively correlated with anti-PSS IgG levels. Thus, we concluded that a preoperative evaluation of antibody response against polysaccharides and serum IgG2 levels can serve to predict development of MRSA-related infection following esophageal surgery.