title: Twenty years of countermeasures against postoperative methicillin-resistant Staphylococcus aureus infections.
abstract: OBJECTIVE
  A total of 7345 cases of digestive organ surgery were investigated over the course of 20 years.
  
  
  METHODS
  Owing to the increasing incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections, we classified our countermeasures into periods A (September 1987 to February 1990), B (March 1990 to February 1997), C (March 1997 to February 1999), D (March 1999 to October 2004), and E (November 2004 to August 2007), and compared the number of infections during these periods. In period B, cefazolin and cefotiam were administered as prophylaxis. The treatment continued for 4 days, including the day of surgery. The patients undergoing endotracheal intubation or tracheotomy were managed with nonscreening pre-emptive isolation and cohorting (NSPEI&C), regardless of whether MRSA was present. However, NSPEI&C was halted in period C, but it was thereafter implemented again, and prophylactic antibiotics were administered only on the day of surgery during period D. In period E, prophylactic antibiotics were administered for 3 days.
  
  
  RESULTS
  In period A, MRSA was contracted in 4.1% (34/833) of patients. In period B, the MRSA isolation rate decreased to 0.3% (8/2722). In period C, the MRSA isolation rate increased to 3.4% (23/681). In period D, the MRSA isolation rate fell to 2.2% (40/1807). In period E, MRSA isolation cases significantly decreased to 0.4% (5/1302; P < 0.002 vs period D).
  
  
  CONCLUSIONS
  The comprehensive management, selection of prophylactic antibiotics, and NSPEI&C were all considered to be effective.
authors.affiliation: Department of Surgery, Toho University Medical Center Ohashi Hospital, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Kusachi
authors.forename: Jiro
authors.initials: J
authors.lastname: Nagao
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Saida
authors.forename: Manabu
authors.initials: M
authors.lastname: Watanabe
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Koji
authors.initials: K
authors.lastname: Asai
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Okamoto
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Arima
authors.forename: Ryohei
authors.initials: R
authors.lastname: Watanabe
authors.forename: Masashi
authors.initials: M
authors.lastname: Uramatsu
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Saito
authors.forename: Takaharu
authors.initials: T
authors.lastname: Kiribayashi
authors.forename: Junko
authors.initials: J
authors.lastname: Sato
mesh_terms: D019072:Antibiotic Prophylaxis; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D010356:Patient Isolation; D013203:Staphylococcal Infections / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*