Surgical-site infection surveillance in cranial neurosurgery

Davies, Benjamin; Jones, Anna; Patel, Hiren C.

doi:10.3109/02688697.2015.1071321

Cited by 20 publications

(18 citation statements)

References 11 publications

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“…5,7 Our data is consistent with this concept, as skin commensals were the most commonly observed organisms responsible for SSI. There has been much debate over which antiseptic agent reduces SSI most efficiently, and many trials have been conducted.…”

Section: Discussionsupporting

confidence: 80%

“…This multifaceted patient follow-up has been shown to be more reliable at identifying SSI than questionnaire-based follow-up alone. 5 The surveillance programme also includes a form that the operating surgeon completes at the time of surgery to record the type of preoperative antisepsis, including the number and type of preparations used. Completing the form was not mandatory, however, and therefore not all cases record this data.…”

Section: Methodsmentioning

confidence: 99%

“…These are defined in line with UK Health Protection Agency (HPA) guidance as requiring one of: purulent discharge; a positive wound culture (superficial or intraoperative); or a clinical diagnosis of infection either at the operative site within 30 days of the procedure or within 1 year where an implant(s) remains. 5,15 Following discharge clinic appointments, telephone consultation or postal questionnaires, alongside daily review of the neurosurgical referral database and hospital readmissions, are monitored to identify SSIs. This multifaceted patient follow-up has been shown to be more reliable at identifying SSI than questionnaire-based follow-up alone.…”

Section: Methodsmentioning

confidence: 99%

“…[1][2][3] In neurosurgery, these consequences, although relatively infrequent, are often more extreme, commonly requiring admission, reoperation and/or prolonged intravenous antibiotic therapy. [4][5][6] Effective preoperative antisepsis is considered a key element in preventing SSIs. The two most commonly used antiseptic agents are chlorhexidine (CHG) and povidone-iodine (PVI).…”

mentioning

confidence: 99%

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Does chlorhexidine and povidone-iodine preoperative antisepsis reduce surgical site infection in cranial neurosurgery?

Davies

Patel

2016

annals

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INTRODUCTION Surgical site infection (SSI) is a significant cause of postoperative morbidity and mortality. Effective preoperative antisepsis is a recognised prophylactic, with commonly used agents including chlorhexidine (CHG) and povidone-iodine (PVI). However, there is emerging evidence to suggest an additional benefit when they are used in combination. METHODS We analysed data from our prospective SSI database on patients undergoing clean cranial neurosurgery between October 2011 and April 2014. We compared the case-mix adjusted odds of developing a SSI in patients undergoing skin preparation with CGH or PVI alone or in combination. RESULTS SSIs were detected in 2.6% of 1146 cases. Antisepsis with PVI alone was performed in 654 (57%) procedures, while 276 (24%) had CHG alone and 216 (19%) CHG and PVI together. SSIs were associated with longer operating time (p<0.001) and younger age (p=0.03). Surgery type (p<0.001) and length of operation (p<0.001) were significantly different between antisepsis groups. In a binary logistic regression model, CHG and PVI was associated with a significant reduction in the likelihood of developing an SSI (adjusted odds ratio [AOR] 0.12, 95% confidence interval [CI] 0.02-0.63) than either agent alone. There was no difference in SSI rates between CHG and PVI alone (AOR 0.60, 95% CI 0.24-1.5). CONCLUSIONS Combination skin preparation with CHG and PVI significantly reduced SSI rates compared to CHG or PVI alone. A prospective, randomized study validating these findings is now warranted.

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Section: Discussionsupporting

confidence: 80%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Does chlorhexidine and povidone-iodine preoperative antisepsis reduce surgical site infection in cranial neurosurgery?

Davies

Patel

2016

annals

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“…In a recent surveillance study by Davies BM et al, the incidence of SSI was 3.5% in 2375 cranial neurosurgical patients, whether prophylactic antibiotics were applied or not wasn't the concern of the study. The incidence of SSI is very close to our study however that study included patients who were readmitted to the hospital (Davies et al 2016).…”

Section: Discussionsupporting

confidence: 69%

Surveillance of the incidence and causative pathogens of meningitis and surgical site infection after craniotomies for brain tumors in neurosugical ICU and ward: a cohort study

Radwan

Fahmy

Hanna

2018

Ain-Shams J Anesthesiol

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Background: Postoperative meningitis and surgical site infections (SSI) is a challenging issue that may result in serious morbidity and mortality. This study aims at decreasing the incidence and identifying the causative pathogens of postoperative meningitis and SSI in patients undergoing craniotomies. Results: The study is a cohort study designed in ASA I and II patients undergoing elective craniotomies for brain tumors, to compare the incidence of meningitis and surgical sites infections between an intervention group who received proposed prophylactic antibiotics from April 2014 to April 2015 and a control group from April 2013 to April 2014 when prophylactic antibiotic protocols were lacking. 488 (four hundred and eighty eight) patients were included. The incidence of meningitis was 3.5% in the pre-protocol group and 2.1% in the post-protocol group (p = 0.331), while that of surgical site infections was 4% in the pre-protocol group and 3.5% in the post-protocol group (p = 0.747). The following pathogens [Pseudomonas,Enterococci, Ecoli and MRSA] decreased, while [klebsiella, Stahpaureus and Acinetobacter] increased after application of the protocol. Conclusions: Although the incidence of both meningitis and surgical site infections decreased after application of the prophylactic antibiotic protocol this was not statistically significant. The main pathogens were mostly gram-negative bacteria which could indicate an alteration of the causative organisms and may modify the choice of prophylactic antibiotics.

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Prophylactic antibiotics in pediatric neurological surgery

Knerlich-Lukoschus

Messing‐Jünger

2018

Childs Nerv Syst

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Surgical-site infection surveillance in cranial neurosurgery

Abstract: These data suggest that active outpatient follow-up is not necessary and that monitoring of inpatients and readmissions is enough for a cranial neurosurgical SSI programme.

Cited by 20 publications

References 11 publications

Does chlorhexidine and povidone-iodine preoperative antisepsis reduce surgical site infection in cranial neurosurgery?

Does chlorhexidine and povidone-iodine preoperative antisepsis reduce surgical site infection in cranial neurosurgery?

Surveillance of the incidence and causative pathogens of meningitis and surgical site infection after craniotomies for brain tumors in neurosugical ICU and ward: a cohort study

Prophylactic antibiotics in pediatric neurological surgery

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