Surgical site infections following craniotomy focusing on possible post-operative acquisition of infection: prospective cohort study

Abstract

Neurosurgery is characterized by a prolonged risk period for surgical site infection (SSI), mainly related to the presence of cerebrospinal fluid (CSF) drains. We aimed to examine factors associated with post-neurosurgical SSIs, focusing on post-operative factors. A prospective cohort study was conducted in a single center over a period of 18 months in Israel. Included were adult patients undergoing clean or clean-contaminated craniotomy, including craniotomies with external CSF drainage or shunts. SSIs were defined by the Centers for Disease Control and Prevention (CDC) criteria for healthcare-associated infections. All patients were followed up for 90 days and those with foreign body insertion for 1 year. We compared patients with and without SSI. A multivariable regression analysis for SSI was conducted including uncorrelated variables significantly associated with SSI. A total of 502 patients were included, with 138 (27.5%) undergoing emergent or urgent craniotomy. The overall SSI rate was 5.6% (28 patients), of which 3.2% (16 patients) were intracerebral. Non-elective surgery, external CSF drainage/monitoring devices, re-operation, and post-operative respiratory failure were independently associated with subsequent SSI. External CSF devices was the only significant risk factor for intracerebral SSIs (p < 0.001). Internal shunts or other foreign body insertions were not associated with SSIs. A phenotypically identical isolate to that causing the SSI was isolated from respiratory secretions prior to the SSI in 4/9 patients with microbiologically documented intracerebral SSIs. Patients with SSIs had longer hospital stay, poorer functional capacity on discharge, and higher 90-day mortality. We raise the possibility of post-operative infection acquisition through external CSF devices. Standard operating procedures for their maintenance are necessary.

The Incidence and Risk Factors of Meningitis after Major Craniotomy in China: A Retrospective Cohort Study

“…The incidence of postneurosurgical meningitis was about 0.3%–8.9% in previous reports [1], [5], [7], [8], [10], [12], [14]–[16], [18], [19], only two of which are comparable to ours because of the similar inclusion criteria for the surgery type [1], [16] 21. In this study, the incidence of meningitis was 8.6%, a little higher than those reports that were focused on craniotomy (0.8%–1.5%) [20].…”

“…Although A. baumannii is less common compared to Staphyloccoci, it has emerged as one of the most troublesome pathogens for healthcare institutions worldwide over the last 15 years [24]. Furthermore, in several studies, especially in those published after 1992, gram-negative rods and Enterobacteriaceae have played an important role [1], [7], [8], [14]–[16], [18], [25]–[28]. Thus, our finding can provide some information for empirical treatment in our institute.…”

Fatores de risco de infecção da ferida operatória em neurocirurgia

“…(22) In a prospective cohort study with 502 patients submitted to craniotomy, the rate of SSI was 5.6%. (23) In order to obtain accurate indicators, (7) postdischarge surveillance is a necessary strategy, considering that 12% to 84% of SSI cases are diagnosed during this period.…”

Facteurs de risque, diagnostic et prise en charge de l’ostéite du volet crânien après craniectomie

“…D'après la base nationale ISO-RAISIN, le taux d'incidence globale des ISO dans les suites des interventions sur le crâne et l'encéphale était de 1,3 % en 2009 (IC 95 % 0,23-2,3). La lecture des données brutes de la littérature permet de retenir un taux d'ISO après craniectomie qui varie de 1 à 10 % [2][3][4][5][6]. Cependant, la plupart des auteurs ont volontairement inclus les OVCc dans le groupe ISO « profondes » pour une meilleure comparaison des données internationales.…”

“…Âge, sexe masculin [14][15][16] ASA 2 [17] Diabète et glycémie préopératoire élevée [11] Alcoolisme [11] Insuffisance respiratoire en postopératoire [5,18] Présence d'une collection sous-galéale préopératoire [9] Facteurs de risque liés à la prise en charge d'une néoplasie intracrânienne active Radiothérapie préalable à la chirurgie [19] Chimiotherapie intraopératorie tel que l'implant de wafers de carmustine (Gliadel 1 ) [20] Facteurs de risque liés à la préparation du patient et à la période péri-opératoire Rasage [21,22] Asepsie cutanée [11,[23][24][25] Absence d'antibioprophylaxie [7] Dysfonction du drainage postopératoire [7] Drainage CSF (cerebrospinal fluid) [5] Facteurs de risque liés à l'acte chirurgical Type de chirurgie (implant, ouverture sinusale, fuite de LCR) [2,4,5,18,26] Ré-intervention, notamment dans le mois qui suit [2,27,28] Durée de l'intervention (notamment > 4 h) [2,[4][5][6]18] Chirurgie réalisée en urgence [2,18] Résection du muscle temporal (ce qui diminue la vascularisation locale) [18] Volume de perte de sang [11] Monitorage de la pression intracranienne > 5 jours [18,29,30] Facteurs de risque liés à la conservation du volet crânien lors d'une repose en 2 temps Cryoconservation …”