Incidence, depth, and severity of surgical site infections after neurosurgical interventions

Abstract

Background Today, there are only few reports on the incidence of surgical site infections (SSIs) in neurosurgery. The objective of this work was to determine the rate of SSI at a tertiary neurosurgical department for benchmarking purpose. Methods Data of consecutive patients undergoing neurosurgical treatment between January 2013 and December 2016 were prospectively entered into a registry. SSIs were diagnosed according to the 2017 Centers for Disease Control and Prevention criteria, with severity graded according to the Clavien-Dindo grade (CDG). We analyzed type and length of surgery (LOS), time to SSI, responsible microorganisms, and its association with the functional status (Karnofsky Performance Status = KPS). Results Of n = 5463 procedures, a SSI occurred in n = 106 (1.94%). The highest rates of SSI occurred after vascular (3.4%) and cerebrospinal fluid (CSF) diversion procedures (3%), as well as after procedures performed to treat a previous complication (2.9%). There was no difference in LOS across procedures with and without SSI. The median time between the index procedure and SSI was 15.5 days. SSIs were most frequently diagnosed after hospital discharge (55%). The most common microorganisms were coagulase-negative staphylococci, Staphylococcus aureus, and Escherichia coli. In 62.3% of cases, SSI required invasive treatment (surgical revision). Patients with SSI in the in-and outpatient setting (SSI occurring after hospital discharge) presented both with a median KPS of 80. Conclusions The current report provides an overview on SSI in a contemporary, unselected, large series of patients undergoing modern neurosurgical care for benchmarking purposes. The overall rate of SSI was about 2%, but subpopulations with higher risks were identified where additional measures could be taken to prevent SSI and monitor patients at risk more closely for SSI.

Risk factors for surgical site infection following craniotomy: a 10-year retrospective cohort study

“…In another study, most SSIs-CRAN occurred within 2 weeks of surgery (9). In our study most patients with SSIs-CRAN were diagnosed after discharge from the hospital, which is similar to the results of related studies (20,21). The most prevalent SSIs were osteomyelitis (66.7%) and/or epidural abscesses (63.6%), as previously reported (7,20,22).…”

“…In 56.1% of patients > 1 microorganism was isolated, with monomicrobial infections occurring in 42.4% of patients. Gram-positive bacteria were isolated in 81.8% of SSIs, which is in agreement with other studies (1,7,9,10,20,21). The most commonly isolated bacterium was Propionibacterium acnes (54.5%), followed by coagulase-negative staphylococci (45.5%) and Staphylococcus aureus (39.4%).…”

Polymerase chain reaction targeting 16S ribosomal RNA for the diagnosis of bacterial meningitis after neurosurgery

“…As previously described, we used a gram-positive coccus (S. aureus) and a gram-negative rod belonging to Enterobacterales (E. coli) because of their common use in method validation (12) and because they are representative of the etiologic agents of surgical site infections, including those of the central nervous system (13). The developed method was then applied to 51 patient samples.…”

Brain abscess – A rare complication of endovascular treatment for acute ischemic stroke

“…Proteus can, however, also enter blood stream through wounds, accounting for up to 4% of surgical site infections in neurosurgical case series. [ 25 ] As such periprocedural infection in this case cannot be excluded and this case highlights the need for rigorous asepsis and proactive treatment of systemic infections in the periprocedural and acute phase following endovascular stroke therapy. [ 27 ]…”