Analysis on risk factors of methicillin-resistant staphylococcus aureus enterocolitis after gastrointestinal surgery / 中华胃肠外科杂志

ABSTRACT

OBJECTIVE@#To investigate the risk factors of methicillin-resistant Staphylococcus aureus(MRSA) enterocolitis after gastrointestinal surgery.@*METHODS@#Clinical and pathological data of 17 cases with MRSA enteritis after gastrointestinal surgery from March 2015 to March 2017 at Department of General Surgery of Affiliated Drum Tower Hospital were retrospectively analyzed.@*INCLUSION CRITERIA@#(1) age of 18 to 80 years;(2) with history of gastrointestinal surgery; (3) diarrhea symptoms within 7 days after gastrointestinal surgery; (4) use of antibiotics before diarrhea; (5) fecal smear showing a large number of gram positive cocci; (6) fecal culture suggested the presence of MRSA; (7) application of antibiotic therapy against MRSA was effective.@*EXCLUSION CRITERIA@#(1)clostridium difficile toxin positive; (2) toxic shock syndrome caused by food poisoning. According to gender, age, and inpatient ward, 12 pairing was performed, and 34 patients with non-MRSA enteritis from the hospitalized cases in the same ward were selected as the control group for retrospective case-control study. There were no significant differences in the gender, age, and constitution index between two groups (all P>0.05), indicating that the two groups were comparable. The χ² test was used to perform univariate analysis on 11 factors, including the nature of the primary disease, colorectal surgery, emergency surgery, use of multiple antibiotics, preoperative bowel preparation, perioperative hormone, intraoperative intraperitoneal chemotherapy, perioperative nasogastric tube, diabetes history, intensive care unit stay, and previous infectious disease hospitalization, and then multivariate logistic regression analysis was performed.@*RESULTS@#MRSA enteritis occurred 3 to 5 days after surgery in all the 17 cases, and 4 cases developed septic shock rapidly. Univariate analysis showed that the operation site (colorectal surgery) (χ²=4.747, P=0.029) and use of two antibiotics before MRSA enteritis (χ²=3.959, P=0.047) were associated with MRSA enteritis after gastrointestinal surgery. Multivariate logistic regression analysis revealed that colorectal surgery was the only independent risk factor for MRSA enteritis after gastrointestinal surgery(OR=5.526, 95%CI 1.350-22.602,P=0.017), while the use of two antibiotics was not (OR=0.204, 95%CI0.051-0.819, P=0.025).@*CONCLUSIONS@#MRSA enteritis has a rapid onset, and a high incidence of septic shock, which requires immediate attention. Colorectal surgery is an independent risk factor for MRSA enteritis.