Methicillin-resistant Staphylococcus aureus infections following esophageal surgery in patients with impaired defense mechanisms

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Abstract
This study was conducted to determine whether or not compromised host defense mechanisms prior to surgery are related to postoperative infections with methicillin-resistant Staphylococcus aureus (MRSA). Neutrophil cytocidal activities, serum complement and immunoglobulin levels, the in vivo antibody-producing capacity against pneumococcal polysaccharide (PPS), and cell-mediated immunity (CMI) were evaluated in 22 patients who underwent esophagectomy for esophageal cancer between 1989 and 1990. Postoperatively, nine patients developed MRSA infections. Anti-PPS IgG was found to be significantly lower in patients with MRSA infections than in those without (P<0.01). All the patients with MRSA infections showed a titer 600 EU. Impairment in other components of the defense mechanisms, apart from a partial deficiency of CMI, did not differ between the groups. Thus, a preoperative evaluation of the antibody-producing capacity may serve to predict the development of MRSA-related infections following major surgery such as esophagectomy.