Nadim Cassir1, Silvestre De La Rosa2, Anthony Melot2, Adamou Touta2, Lucas Troude3, Anderson Loundou3, Hervé Richet4, Pierre-Hugues Roche2. 1. Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UM63, CNRS 7278, IRD 198, Inserm 1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Aix-Marseille-Université, Marseille, France. Electronic address: cassirnadim@gmail.com. 2. Service de Neurochirurgie, CHU Nord, Marseille, France. 3. Unité de Recherche de Santé Publique et Maladies Chroniques, Université Aix-Marseille, Marseille, France. 4. Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UM63, CNRS 7278, IRD 198, Inserm 1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Aix-Marseille-Université, Marseille, France.
Abstract
BACKGROUND: Surgical site infection (SSI) after neurosurgery has potentially devastating consequences. METHODS: A prospective cohort study was conducted over a period of 24 months in a university center. All adult patients undergoing neurosurgical procedures, with exception of open skull fractures, were included. Multivariate logistic regression analysis was used to identify independent risk factors. RESULTS: We included 949 patients. Among them, 43 were diagnosed with SSI (4.5%). A significant reduction in postneurosurgical SSI from 5.8% in 2009 to 3.0% in 2010 (P = .04) was observed. During that period, an active surveillance with regular feedback was established. The most common microorganisms isolated from SSI were Staphylococcus aureus (23%), Enterobacteriaceae (21%), and Propionibacterium acnes (12%). We identified the following independent risk factors for SSI postcranial surgery: intensive care unit (ICU) length of stay ≥7 days (odds ratio [OR] = 6.1; 95% confidence interval [CI], 1.7-21.7), duration of drainage ≥3 days (OR = 3.3; 95% CI, 1.1-11), and cerebrospinal fluid leakage (OR = 5.6; 95% CI, 1.1-30). For SSIs postspinal surgery, we identified the following: ICU length of stay ≥7 days (OR = 7.2; 95% CI, 1.6-32.1), coinfection (OR = 9.9; 95% CI, 2.2-43.4), and duration of drainage ≥3 days (OR = 5.7; 95% CI, 1.5-22). CONCLUSION: Active surveillance with regular feedback proved effective in reducing SSI rates. The postoperative period is associated with overlooked risk factors for neurosurgical SSI. Infection control measures targeting this period are therefore promising.
BACKGROUND: Surgical site infection (SSI) after neurosurgery has potentially devastating consequences. METHODS: A prospective cohort study was conducted over a period of 24 months in a university center. All adult patients undergoing neurosurgical procedures, with exception of open skull fractures, were included. Multivariate logistic regression analysis was used to identify independent risk factors. RESULTS: We included 949 patients. Among them, 43 were diagnosed with SSI (4.5%). A significant reduction in postneurosurgical SSI from 5.8% in 2009 to 3.0% in 2010 (P = .04) was observed. During that period, an active surveillance with regular feedback was established. The most common microorganisms isolated from SSI were Staphylococcus aureus (23%), Enterobacteriaceae (21%), and Propionibacterium acnes (12%). We identified the following independent risk factors for SSI postcranial surgery: intensive care unit (ICU) length of stay ≥7 days (odds ratio [OR] = 6.1; 95% confidence interval [CI], 1.7-21.7), duration of drainage ≥3 days (OR = 3.3; 95% CI, 1.1-11), and cerebrospinal fluid leakage (OR = 5.6; 95% CI, 1.1-30). For SSIs postspinal surgery, we identified the following: ICU length of stay ≥7 days (OR = 7.2; 95% CI, 1.6-32.1), coinfection (OR = 9.9; 95% CI, 2.2-43.4), and duration of drainage ≥3 days (OR = 5.7; 95% CI, 1.5-22). CONCLUSION: Active surveillance with regular feedback proved effective in reducing SSI rates. The postoperative period is associated with overlooked risk factors for neurosurgical SSI. Infection control measures targeting this period are therefore promising.
Authors: Emilio Garzón Cediel; Varina Louise Boerwinkle; Juan Fernando Ramon; Diana Arias; Jose Antonio De la Hoz-Valle; Jose Dario Mercado; Darwin Cohen; Maria Claudia Niño Journal: Surg Neurol Int Date: 2022-03-04
Authors: Simon G Ammanuel; Caleb S Edwards; Andrew K Chan; Praveen V Mummaneni; Joseph Kidane; Enrique Vargas; Sarah D'Souza; Amy D Nichols; Sujatha Sankaran; Adib A Abla; Manish K Aghi; Edward F Chang; Shawn L Hervey-Jumper; Sandeep Kunwar; Paul S Larson; Michael T Lawton; Philip A Starr; Philip V Theodosopoulos; Mitchel S Berger; Michael W McDermott Journal: J Neurosurg Date: 2021-04-30 Impact factor: 5.408