Abstract
Enterocolitis caused by methicillin-resistant Staphylococcus aureus (MRSA) has recently been recognized as one of the severe postoperative complications in surgery on the digestive organs. This disease often occurs in the early days after gastrointestinal operation, especially after gastrectomy. MRSA enterocolitis seems to occur when MRSA has first infected the naso-pharyngeal mucosa preoperatively, and then moved into the stomach, and subsequently proliferated in the higher pH gastric juices.
The aim of this experiment was to reveal the relationship between the acidity of gastric juices and bacterial growth in the stomach during the pre and post operative period in an effort to prevent of MRSA enterocolitis.
In vitro, MRSA was cultured for various periods at various pH values, and its proliferation was observed. MRSA did not grow in the culture at pH 1 at all, neither did it grow at pH 2 when cultured for more than 8 hours. This data shows the germicidal effect of high acidity in the stomach. Clinically, twenty patients with cancer in the digestive tract had the bacteria in their gastric juices examined in terms of acidity before and after operation. In cases with an increased pH level in the gastric juices after the operation, S. aureus including MRSA, was isolated frequently from the stomach. In vitro, incubation of MRSA with gastric juices collectd from those cases showed no development of MRSA when the pH was below 3.98.
In order to prevent the onset of MRSA enterocolitis, the remnant stomachs of ten patients with stomach cancer were filled with hydrochloric acid lemonade just after operative reconstruction. After this treatment, gram-positive organisms including S. aureus decreased in number in the stomach.
In conclusion, keeping the acidity of the gastric juices high is an effective means of reducing bacteria in the stomach. It is suggested that the administration of hydrochloric acid lemonade through a naso-gastric tube into the remnant of the stomach will reinforce the barrier inside the stomach against MRSA and will be very effective in preventing enterocolitis.
