Surgical Site Infections After Neurosurgical Procedures in Ukraine: Results of a Multicenter Study (2018-2020)

Abstract

The aim: To obtain the first estimates the incidence of surgical site infection in patients undergoing neurosurgical procedures and antimicrobial resistance of responsible pathogens, and determine their impact on inpatient mortality in Ukraine. Materials and methods: We performed a multicenter prospective study was patient-based data of SSIs were according to CDC/NHSN methodology. This study included patients undergoing a neurosurgical procedure in 11 tertiary care hospitals from different regions of Ukraine from January 1st, 2018 to December 31st, 2020. Results: A total of 1697 neurosurgical procedures associated with a 90-day SSI were identified (19.4% of 8741 procedures). Of these, 69.5% SSI were identified after craniotomy and 30.5% after ventricular shunt. The Meningitis or ventriculitis (20.9%) were found to be the most common underlying condition among these patients followed by Intracranial infection (18.7%), and Osteomyelitis (14.6%) congenital malformation. Over a 90-day surveillance period, 387 died (4.4%). Fifty seven percent of deaths in SSI patients were attributable to infection. Meningitis or ventriculitis and Intracranial infection were associated with a higher mortality. Craniotomy was associated with a higher mortality more frequently than did Ventricular shunt. Escherichia coli were most commonly reported, accounting for 26.3% of all organisms, followed by Staphylococcus aureus, Enterobacter spp., Pseudomonas aeruginosa, Enterococcus spp., and Klebsiella pneumoniae. Meticillin resistance was found in 33.7% of S. aureus isolates, and vancomycin resistance was found in 12.7% of enterococci. Conclusions: The incidence of SSI and mortality after neurosurgical procedures in Ukraine is high. This is due to increase emergence of antimicrobial-resistant pathogens and risk factors in neurosurgery patients.

Appraising war's impacts on neurosurgical delivery in Ukraine

“…1 In addition, the conflict has forced 7.83 million people to abandon the country and seek refuge in the west.Preceeding the war, Ukraine's healthcare system performed the lowest among 43 European nations, according to MacKenbach's analysis, 2 making it subpar by both European and international standards. Moreover, neurosurgical care in Ukraine was found to be substandard, with a high rate of post-neurosurgical complications and mortality, according to a multicenter study by Aidyn et al 3 The majority of these fatalities and issues were caused by a plethora of factors, including outdated surgical techniques, limited surgical personnel, poor surgical abilities, and substandard cleaning procedures. 3 The recent conflict in the nation has undoubtedly worsened the situation and jeopardised the whole healthcare system in Ukraine, with the surgical field bearing the brunt of the surgical burden and traumatising patients.…”

“…Moreover, neurosurgical care in Ukraine was found to be substandard, with a high rate of post-neurosurgical complications and mortality, according to a multicenter study by Aidyn et al 3 The majority of these fatalities and issues were caused by a plethora of factors, including outdated surgical techniques, limited surgical personnel, poor surgical abilities, and substandard cleaning procedures. 3 The recent conflict in the nation has undoubtedly worsened the situation and jeopardised the whole healthcare system in Ukraine, with the surgical field bearing the brunt of the surgical burden and traumatising patients. The Ukrainian government and the international community have worked effortlessly to enhance the nation's surgical…”