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

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, while all but one of the non-infected patients 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.