1995 Volume 43 Issue 1 Pages 1-11
Bacterial culture of the nasal cavity, throat, and feces was carried out in 40 patients who underwent gastrointestinal surgery. Twenty patients had rectal or colon cancer, 11 had gastric cancer, 5 had esophageal cancer, and 4 had other diseases. Except for 2 patients, none of the patients with esophageal cancer and gastric cancer received preoperative antibiotics. Kanamycin and metronidazole were administered to patients prior to intestinal surgery. Twenty-eight patients received cefazolin as postoperative chemotherapy, 8 patients received flomoxef, 2 received cefotiam, and 2 received cefmetazole. Comparison of cultures obtained before and after surgery showed that isolation of methicillin-resistant Staphylococcus aureus (MRSA) from the nasal cavity and throat increased markedly, from 2 to 8 patients and from 2 to 13 patients, respectively. In 6 patients with more than 103CFU/ml of bacteria, MRSA was isolated from both the nasal cavity and throat. In these MRSA-positive patients, cultures for MRSA remained positive after removal of the nasogastric tube. In patients in whom methicillin-susceptible S. aureus (MSSA) was isolated from the nasal cavity and throat before surgery, the bacteria were eradicated by postoperative chemotherapy in most cases. Before surgery, gram-negative organisms were isolated from the nasal cavity and throat in only a few patients, but the isolation rates of these bacteria increased significantly following postoperative chemotherapy. In particular, the isolation rates of Klebsiella spp, Enterobacter spp, Pseudomonas spp, and Acinetobacter spp were high. Cultures for these bacteria remained positive after removal of the nasogastric tube. Postoperative these bacteria remained positive after removal of the nasogastric tube. Postoperative infection occurred in 8 patients. In all but 1 patient, the onset was 5 days or more after surgery. The causative bacteria suspected or identified were mainly MRSA and Pseudomonas aeruginosa. It was noted that these bacteria had been isolated from the throat 3 days after surgery. The results of this study suggest that performing bacterial culture (monitoring culture) of the nasal cavity and throat before and after gastrointestinal surgery is useful for the prevention of postoperative infection.
