Evaluation of neurosurgical implant infection rates and associated pathogens: evidence from 1118 postoperative infections

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Various implanted materials are used in neurosurgery; however, there remains a lack of pooled data on infection rates (IRs) and infective bacteria over past decades. The goal of this study was to investigate implant infections in neurosurgical procedures in a longitudinal retrospective study and to evaluate the IRs of neurosurgically implanted materials and the distribution of pathogenic microorganisms.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A systematic literature search was conducted using PubMed and Web of Science databases for the time period between 1968 and 2018. Neurosurgical implant infections were studied in 5 subgroups, including operations or diseases, implanted materials, bacteria, distribution by country, and time periods, which were obtained from the literature and statistically analyzed. In this meta-analysis, statistical heterogeneity across studies was tested by using p values and I<jats:sup>2</jats:sup> values between studies of associated pathogens. Egger’s test was used for assessing symmetries of funnel plots with Stata 11.0 software. Methodological quality was assessed to judge the risk of bias according to the Cochrane Handbook.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A total of 22,971 patients from 227 articles satisfied the study’s eligibility criteria. Of these, 1118 cases of infection were reported, and the overall IR was 4.87%. In this study, the neurosurgical procedures or disorders with the top 3 IRs included craniotomy (IR 6.58%), cranioplasty (IR 5.89%), and motor movement disorders (IR 5.43%). Among 13 implanted materials, the implants with the top 3 IRs included polypropylene-polyester, titanium, and polyetheretherketone (PEEK), which were 8.11%, 8.15%, and 7.31%, respectively. Furthermore, the main causative pathogen was <jats:italic>Staphylococcus aureus</jats:italic> and the countries with the top 3 IRs were Denmark (IR 11.90%), Korea (IR 10.98%), and Mexico (IR 9.26%). Except for the low IR from 1998 to 2007, the overall implant IR after neurosurgical procedures was on the rise.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>In this study, the main pathogen in neurosurgery was <jats:italic>S. aureus</jats:italic>, which can provide a certain reference for the clinic. In addition, the IRs of polypropylene-polyester, titanium, and PEEK were higher than other materials, which means that more attention should be paid to them. In short, the total IR was high in neurosurgical implants and should be taken seriously.</jats:p></jats:sec>

Infections in Neurosurgery and Their Management

“…Regardless of indications for performing craniectomy followed by cranioplasty, the infection rates for this neurosurgical procedure compared to the other procedures is higher. In a broad-based study in 2019 by Ying Chen et al, it was revealed that after craniotomies (6.58% Infection rate), cranioplasties had the highest infection rate (5.89%) in neurosurgical procedures [9]. Infections in cranioplasty procedures can occur early or late in the post-operative period.…”

“…The most common implants used in spine surgery are screws, rods and intervertebral cages. Different materials such as polypropylene-polyester, titanium, and polyetheretherketone (PEEK) are used in spinal surgeries and a study in 2019 revealed that the above-mentioned materials among all other materials used in neurosurgical procedures have the highest rate for infection [9]. Fusion surgeries require the removal of the intervertebral disk and implantation of an intervertebral cage, this in turn can cause spondylodiscitis which in turn can cause colonization and infection of the implanted screws and cages.…”

Are preoperative chlorhexidine gluconate showers associated with a reduction in surgical site infection following craniotomy? A retrospective cohort analysis of 3126 surgical procedures

“…Third, stringent criteria were used to determine each SSI (i.e., SSI definitions of the National Healthcare Safety Network), possibly leading to a lower rate of infection of 0.6% compared with reports of 1.6%-9% in the literature. 23,41,42 Our SSI rate may not account for patients whose admissions for SSI were outside the University of California, San Francisco system. Indeed, these may not have been captured by the data provided to us by the National Healthcare Safety Network.…”

Immunopathogenesis of Craniotomy Infection and Niche-Specific Immune Responses to Biofilm

“…Approximately one half of craniotomy/craniectomy infections are attributed to S. aureus ( 7 , 16 – 18 ), a gram-positive pathogen that forms a biofilm on native bone ( 19 ). Infections can be caused by other bacteria and fungi, although these occur at a much lower rate ( 8 , 17 ). Around 30% of the human population is colonized with S. aureus , typically in the nares and skin, and colonized individuals have an increased risk for invasive S. aureus infection ( 20 ).…”