Surgical Site Infection after Malignant Brain Tumor Resection: A Multicenter Study for Induction of a Basic Care Bundle

Uzuka, Takeo; Takahashi, Hideaki; Nakasu, Yoko; Okuda, Takeshi; Mitsuya, Koichi; Hayashi, Nakamasa; Hirose, Takayuki; Kurai, Hanako

doi:10.2176/nmc.oa.2017-0034

Cited by 23 publications

(22 citation statements)

References 13 publications

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“…etc. but the most commonly isolated organism was S. aureus (30). Separate studies by Rolston et al, Bhat et al, and Uzuka et al also confirmed these findings.…”

Section: Discussionmentioning

confidence: 76%

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Bacterial Etiology of Wound Exudates in Tertiary Care Cancer Patients and Antibiogram of the Isolates

et al. 2020

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Introduction: Patients with malignancies frequently develop infections as a result of surgical procedures and fungating wounds leading to pus formation. This cross-sectional study was conducted to explore the bacteriological spectra of infections of various cancer sites and their antibiotic sensitivity patterns among the patients visiting minor operation theatre (OT) of B.P. Koirala Memorial Cancer Hospital (BPKMCH), Chitwan, Nepal. Methods: Over a period of 3 months from September to November 2018, a total of 183 wound exudates and pus samples were collected and analyzed by standard microbiological procedures. Isolates were identified based on the colony characters, Gram staining and an array of biochemical tests. Antibiotic susceptibility testing was performed by Kirby-Bauer disc diffusion technique according to criteria set by CLSI, 2016. Methicillin resistance in Staphylococcus aureus was tested with the help of cefoxitin using disc diffusion method. Results: Out of the 183 samples, 149 (81.4%) were culture positive. Among 13 different isolates identified, S. aureus (43.0%) was predominant followed by E. coli (14.0%). Higher incidence of bacteria was seen among the males (52.3%), in the age group 51 to 60 years (26.8%) and among the patients undergoing surgical intervention to deal with cancer (34.2%). The prevalence of wound infection was significantly affected by gender, age, and treatment regimen ( P < .01). Out of the total 68 S. aureus isolates, 38 (44.1%) were deemed as Methicillin-resistant Staphylococcus aureus (MRSA). Among the 158 isolates, 85 (53.8%) were multi-drug resistant (MDR). Cefepime was the most effective antibiotic for Gram positive isolates whereas both imipenem and meropenem were found to be equally more effective for Gram negative isolates. Conclusion: This study suggests that patients with malignancies harbor pathogenic bacteria; therefore, prudent use of antibiotics is essential to prevent the emergence of MDR pathogens.

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“…etc. but the most commonly isolated organism was S. aureus (30). Separate studies by Rolston et al, Bhat et al, and Uzuka et al also confirmed these findings.…”

Section: Discussionmentioning

confidence: 76%

“…Separate studies by Rolston et al, Bhat et al, and Uzuka et al also confirmed these findings. 22,29,30 High prevalence of S. aureus may be due to its distribution in the human body. Other normal flora like E. coli, K. pneumoniae, Citrobacter sp.…”

Section: Discussionmentioning

confidence: 99%

Bacterial Etiology of Wound Exudates in Tertiary Care Cancer Patients and Antibiogram of the Isolates

et al. 2020

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“…A recent study by Uzuka T et. al [ 13 ] reported no significant difference in the frequency of surgical site infection (SSI) between supratentorial and infratentorial malignant brain tumor. This study, however, may have been underpowered as we found a significantly higher incidence of S/SS in our infratentorial tumor group when compared to the supratentorial tumor group ( p = 0.0019).…”

Section: Discussionmentioning

confidence: 99%

Sepsis and septic shock after craniotomy: Predicting a significant patient safety and quality outcome measure

Zhang

Pieters

et al. 2020

PLoS ONE

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Objectives Sepsis and septic shock are important quality and patient safety metrics. This study examines incidence of Sepsis and/or septic shock (S/SS) after craniotomy for tumor resection, one of the most common neurosurgical operations. Methods Multicenter, prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was used to identify patients undergoing craniotomy for tumor (CPT 61510, 61521, 61520, 61518, 61526, 61545, 61546, 61512, 61519, 61575) from 2012–2015. Univariate and multivariate logistic regression models were used to identify risk factors for S/SS. Results There were 18,642 patients that underwent craniotomy for tumor resection. The rate of sepsis was 1.35% with a mortality rate of 11.16% and the rate of septic shock was 0.65% with a 33.06% mortality rate versus an overall mortality rate of 2.46% in the craniotomy for tumor cohort. The 30-day readmission rate was 50.54% with S/SS vs 10.26% in those without S/SS. Multiple factors were identified as statistically significant ( p <0.05) for S/SS including ascites (OR = 33.0), ventilator dependence (OR = 4.5), SIRS (OR = 2.8), functional status (OR = 2.3), bleeding disorders (OR = 1.7), severe COPD (OR = 1.6), steroid use (OR = 1.6), operative time >310 minutes (OR = 1.5), hypertension requiring medication (OR = 1.5), ASA class ≥ 3 (OR = 1.4), male sex (OR = 1.4), BMI >35 (OR = 1.4) and infratentorial location. Conclusions The data indicate that sepsis and septic shock, although uncommon after craniotomy for tumor resection, carry a significant risk of 30-day unplanned reoperation (35.60%) and mortality (18.21%). The most significant risk factors are ventilator dependence, ascites, SIRS and poor functional status. By identifying the risk factors for S/SS, neurosurgeons can potentially improve outcomes. Further investigation should focus on the creation of a predictive score for S/SS with integration into the electronic health record for targeted protocol initiation in this unique neurosurgical patient population.

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“…This study strengthens the knowledge that various risk factors are associated with the development of SSIs, with few of these risk factors being modifiable. Smoking, diabetes, operative duration and perioperative dexamethasone have all been shown to inhibit satisfactory wound healing, 1,5,9 which could in turn lead to wound leaks.…”

Section: Prevention Strategiesmentioning

confidence: 99%

“…Surgical site infections (SSIs) are of profound significance in a healthcare setting, both in terms of patient outcomes and healthcare costs. SSI rates have been described in the literature as accounting for 1.1-19.78% of all healthcare associated infections 1 and they create an additional cost to the National Health Service (NHS) of £2,100-£10,500 per infected case. 2 The need for further surgical intervention to treat SSIs increases this cost owing to extended postoperative hospital stays, prolonged intravenous antibiotic treatment, delayed wound healing and extended inpatient rehabilitation times.…”

mentioning

confidence: 99%

Risk factors for surgical site infections in neurosurgery

Patel

Thompson

Innocent

et al. 2019

annals

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Introduction Surgical site infections (SSIs) are of profound significance in neurosurgical departments, resulting in high morbidity and mortality. There are limited public data regarding the incidence of SSIs in neurosurgery. The aim of this study was to determine the rate of SSIs (particularly those requiring reoperation) over a seven-year period and identify factors leading to an increased risk. Methods An age matched retrospective analysis was undertaken of a series of 16,513 patients at a single centre. All patients who required reoperation for suspected SSIs within a 7-year period were identified. Exclusion criteria comprised absence of infective material intraoperatively and patients presenting with primary infections. Clinical notes were reviewed to confirm presence or absence of suspected risk factors. Results Of the 16,513 patients in the study, 1.20% required at least one further operation to treat a SSI. Wound leak (odds ratio [OR]: 27.41), dexamethasone use (OR: 3.55), instrumentation (OR: 2.74) and operative duration >180 minutes (OR: 1.85) were statistically significant risk factors for reoperation. Conclusions This is the first UK study of such a duration that has documented a SSI reoperation rate in a cohort of this size. Various risk factors are associated with the development of SSIs, making it essential to have robust auditing and monitoring of high risk patients to ensure excellent standards of healthcare. Departmental and public registers to record all SSIs may be beneficial, particularly for those treated solely by general practitioners, allowing units to address potential risk factors prior to surgical intervention.

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Surgical Site Infection after Malignant Brain Tumor Resection: A Multicenter Study for Induction of a Basic Care Bundle

Cited by 23 publications

References 13 publications

Bacterial Etiology of Wound Exudates in Tertiary Care Cancer Patients and Antibiogram of the Isolates

Bacterial Etiology of Wound Exudates in Tertiary Care Cancer Patients and Antibiogram of the Isolates

Sepsis and septic shock after craniotomy: Predicting a significant patient safety and quality outcome measure

Risk factors for surgical site infections in neurosurgery

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