Outcome of LMME may be improved by appropriate empirical antibiotic therapy, suspicion and careful management of hydrocephalus. Use of adjuvant dexamethasone or phenytoin in a subgroup of these patients might have a benefit.
This is the largest series of VP shunt infections in adults reported to date. VP shunt removal, particularly TSSR when the patient is shunt dependent, remains the optimal choice of treatment and does not increase morbidity.
Background
Although surgical site infection after craniotomy (SSI-CRAN) is a serious complication, risk factors for its development have not been well defined. We aim to identify the risk factors for developing SSI-CRAN in a large prospective cohort of adult patients undergoing craniotomy.
Methods
A series of consecutive patients who underwent craniotomy at a university hospital from January 2013 to December 2015 were prospectively assessed. Demographic, epidemiological, surgical, clinical and microbiological data were collected. Patients were followed up in an active post-discharge surveillance programm e for up to one year after surgery. Multivariate analysis was carried out to identify independent risk factors for SSI-CRAN.
Results
Among the 595 patients who underwent craniotomy, 91 (15.3%) episodes of SSI-CRAN were recorded, 67 (73.6%) of which were organ/space. Baseline demographic characteristics were similar among patients who developed SSI-CRAN and those who did not. The most frequent causative Gram-positive organisms were
Cutibacterium acnes
(23.1%) and
Staphylococcus epidermidis
(23.1%), whereas
Enterobacter cloacae
(12.1%) was the most commonly isolated Gram-negative agent. In the univariate analysis the factors associated with SSI-CRAN were ASA score > 2 (48.4% vs. 35.5% in SSI-CRAN and no SSI-CRAN respectively,
p
= 0.025), extrinsic tumour (28.6% vs. 19.2%,
p
= 0.05), and re-intervention (4.4% vs. 1.4%,
p
= < 0.001). In the multivariate analysis, ASA score > 2 (AOR: 2.26, 95% CI: 1.32–3.87;
p
= .003) and re-intervention (OR: 8.93, 95% CI: 5.33–14.96;
p
< 0.001) were the only factors independently associated with SSI-CRAN.
Conclusion
The risk factors and causative agents of SSI-CRAN identified in this study should be considered in the design of preventive strategies aimed to reduce the incidence of this serious complication.
Electronic supplementary material
The online version of this article (10.1186/s13756-019-0525-3) contains supplementary material, which is available to authorized users.
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