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Infections in neurosurgery: A retrospective study of 1143 patients and 1517 operations

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Summary

The files of 1143 neurosurgical patients, operated on between November 1, 1979 and June 4, 1981 were examined for records of post-operative infections. Eighty-three patients had developed infections (7%). In addition there were 33 instances of aseptic meningitis. Patients with a shunt were prone to infection (12%). Bone flap infections accounted for more than half of all infections after supratentorial craniotomy. Bacterial meningitis accounted for more than half of all infections after suboccipital craniotomy and translabyrinthine operations. In these patients bacterial meningitis was six times more common, and aseptic meningitis three times more common than in those who had had supratentorial operations. Shunt infection was more common after repeated shunt operations in quick succession. Craniotomy increased the risk of a shunt becoming infected.

Antibiotic prophylaxis should be used not only in shunt operations but in all operations performed on patients with a shunt. If bacteria are recovered in a suspected shunt infection, immediate removal of the shunt is the best treatment. However, if the shunt's removal or replacement is exceptionally difficult intraventricular antibiotic treatment may be tried. The age of the patient, the duration of the operation, the individual surgeon and the number of operations did not affect the rate of infection. Clinical signs and conventional laboratory tests, apart from bacterial culture, cannot differentiate between bacterial and aseptic meningitis, but a drop in the level of consciousness suggests bacterial meningitis.

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References

  1. Adams, J., Fifth annual report, Division of neurological surgery, University of California School of Medicine, San Francisco, California 1963.

    Google Scholar 

  2. Alexander, J. W., Altemeier, W. A., Penicillin prophylaxis of experimental staphylococcal wound infections. Surg. Gynec. Obstet.120 (1961), 243–254.

    Google Scholar 

  3. Alpert, S., Salzman, T., Sullivan, C., Palmer, C., Stevenson S. M., Use of surgical isolator for major surgery: influence on wound contamination and post-operative wound infection. In: Hennegham: Germ-free research, pp. 87–95. New York: Academic Press. 1973.

    Google Scholar 

  4. Balch, R. E., Wound infection complicating neurosurgical procedures. J. Neurosurg.26 (1967), 41–45.

    PubMed  Google Scholar 

  5. Baldwin, M., Fox, D. G., Laminar flow for the neurosurgical operating room: technical note J. Neurosurg.29 (1968), 660–665.

    PubMed  Google Scholar 

  6. Bayston, R., Penny, S. R., Excessive production of mucoid substance in Staphylococcus SIIA: a possible factor in colonization of Holter shunts. Dev. Med. Child. Neurol.14 (Suppl. 27) (1972), 25–28.

    Google Scholar 

  7. Bayston, R., Lari, J., A study of the sources of infection in colonised shunts. Dev. Med. and Child Neurol.16 (1974), 16–21.

    Google Scholar 

  8. Bayston, R., Antibiotic prophylaxis in shunt surgery. Dev. Med. and Child Neurol.17 Suppl. 35 (1975), 99–103.

    Google Scholar 

  9. Black, J. A., Challacombe, D. N., Ockenden, B. G., Nephrotic syndrome associted with bacteraemia after shunt operations for hydrocephalus. Lancetii (1965), 921–924.

    Google Scholar 

  10. Burke, J. F., The effective period of preventive antibiotic action in experimental incision and dermal lesions. Surgery50 (1961), 161–168.

    Google Scholar 

  11. Cairns, H., Bacterial infections during intracranial operations. Lancet1 (1963), 1193–1198.

    PubMed  Google Scholar 

  12. Carmel, P. W., Fraser, R. A. R., Stein, B. M., Aseptic meningitis following posterior fossa surgery on children. J. Neurosurg.41 (1974), 44–48.

    PubMed  Google Scholar 

  13. Chan, R. C., Thompson, G. B., Morbidity, mortality, and quality of life following surgery for intracranial meningiomas. J. Neurosurg.60 (1984), 52–60.

    PubMed  Google Scholar 

  14. Chou, S. N., Erickson, D. L., Craniotomy infections. Clin. Neurosurg.23 (1976), 357–362.

    PubMed  Google Scholar 

  15. Cushing, H., Eisenhardt, L., Meningiomas: Their Classification, Regional Behavior, Life History, and Surgical End Results. Springfield, Ill.: Ch. C Thomas. 1938.

    Google Scholar 

  16. Eiselberg, A. von, Ronzi, E., Über die chirurgische Behandlung der Hirn- und Rückenmarkstumoren. Arch. Klin. Chir.102 (1913), 309–468.

    Google Scholar 

  17. Everett, E. D., Eickhoff, T. C., Simon, R. H., Cerebrospinal fluid shunt infection with anaerobic diphtheroids (Propionbacterium species). J. Neurosurg.44 (1976), 580–584.

    PubMed  Google Scholar 

  18. Feindel, W., Neurosurgery. In: 29th annual report of the Montreal Neurological Institute of McGill University 1964.

  19. Finlayson. A. I., Penfield, W., Acute post-operative aseptic leptomeniningitis. Arch. Neurol. Psychiat.46 (1941), 250–276.

    Google Scholar 

  20. Fokes, E. C., Occult infections of ventriculoatrial shunts. J. Neurosurg.33 (1970), 517–523.

    PubMed  Google Scholar 

  21. Forward, K. R., Fewer, H. D., Stiver, H. G., Cerebrospinal fluid shunt infections. A review of 35 infections in 32 patients. J. Neurosurg.59 (1983), 389–394.

    PubMed  Google Scholar 

  22. George, R., Leibrock, L., Epstein, M., Long-term analysis of cerebrospinal fluid shunt infections. A 25-year experience. J. Neurosurg.51 (1979), 804–811.

    PubMed  Google Scholar 

  23. Geraghty, J., Feely, M., Antibiotic prophylaxis in neurosurgery. A randomized controlled trial. J. Neurosurg.60 (1984), 724–726.

    PubMed  Google Scholar 

  24. Green, J. R., Kanshepolsky, J., Turkian, B., Incidence and significance of central nervous system infection in neurosurgical patients. Adv. Neurol.6 (1974), 223–228.

    PubMed  Google Scholar 

  25. Haines, S. J., Taylor, F., Prophylactic methicillin for shunt operations: effect on incidence of shunt malfunction and infection. Child's Brain9 (1982), 10–22.

    PubMed  Google Scholar 

  26. Harkiss, G. D., Brown, D. L., Evans, D. B., Longitudinal study of circulating immune complexes in a patient with Staphylococcus albus-induced shunt nephritis. Clin. exp. Immunol.37 (1979), 228–238.

    PubMed  Google Scholar 

  27. Howes, E. L., Prevention of wound infection by injection of nontoxic antibacteria substances. Ann. Surg.124 (1946), 268.

    Google Scholar 

  28. Hughes, G. B., Glasscock, M. E., Hays, J. W., Jackson, C. G., Sismanis, A., Cerebrospinal fluid “leaks” and meningitis following acoustic tumour surgery. Otolaryngol. Head Neck Surg.90 (1982), 117–125.

    PubMed  Google Scholar 

  29. Jackson, I. J., Aseptic hemogenic meningitis. Arch. Neurol. Psychiat.65 (1949), 572–589.

    Google Scholar 

  30. James, H. E., Walsh, J. W., Wilson, H. D., Connor, J. D., The management of cerebrospinal fluid shunt infections. A clinical experience. Acta Neurochir. (Wien)59 (1981), 157–166.

    Google Scholar 

  31. Jomin, M., Lesoin, F., Lozes, G., 500 ruptured and operated intracranial arterial aneurysms. Surg. Neurol.21 (1984), 13–18.

    PubMed  Google Scholar 

  32. Keucher, T. R., Mealy, J., Long-term results after ventriculoatrial and ventriculoperitoneal shunting for infantile hydrocephalus. J. Neurosurg.50 (1979), 179–186.

    PubMed  Google Scholar 

  33. Klastersky, J., Sadeghi, M., Brihaye, J., Antimicrobial prophylaxis in patients with rhinorrhea or otorrhea: A doubleblind study. Surg. Neurol.6 (1976), 111–114.

    PubMed  Google Scholar 

  34. Klastersky, J., Kahan-Coppens, L., Brihaye, J., Infection in neurosurgery. In: Advances and Technical Standards in Neurosurgery (Krayenbühl, H.,et al., eds.), Vol. 6, pp. 39–54. Wien-New York: Springer. 1979.

    Google Scholar 

  35. Lerner, P. I., Selection of antimicrobial agents in bacterial infection of the nervous system. Adv. Neurol.6 (1974), 169–203.

    PubMed  Google Scholar 

  36. Luthardt, T., Bacterial infections in ventriculo-auricular shunt systems. Dev. Med. Child. Neurol. 12 Suppl. 22 (1970), 105–109.

    Google Scholar 

  37. Malis, L. I., Prevention of neurosurgical infection by intraoperative antibiotics. Neurosurg.5 (1979), 339–343.

    Google Scholar 

  38. Mates, S., Glaser, J., Shapiro, K., Treatment of cerebrospinal fluid infections with medical therapy alone. Neurosurg.11 (1982), 781–783.

    Google Scholar 

  39. McCarthy, M. F., Wenzel, R. P., Postoperative spinal fluid infections after neurosurgical shunting procedures. Pediatrics59 (1977), 793.

    PubMed  Google Scholar 

  40. McLaurin R., Treatment of infected ventricular shunts. Child's Brain1 (1975), 306–310.

    PubMed  Google Scholar 

  41. Morrice, J. J., Young, D. G., Bacterial colonisation of Holter valves: a ten-year survey. Dev. Med. Child Neurol.16 Suppl.32 (1974), 85–90.

    Google Scholar 

  42. Naito, H., Toya, S., Shizawa, H., Iizaka, Y., Tsukumo, D., High incidence of acute postoperative meningitis and septicemia in patients undergoing craniotomy with ventriculoatrial shunt. Surg. Gynec. Obstet.137 (1973), 810–812.

    PubMed  Google Scholar 

  43. Nicholas, J. L., Kamal, I. M., Eckstein, H. B., Immediate shunt replacement in the treatment of bacterial colonisation of Holter valves. Dev. Med. Child Neurol.12 Supp. 22 (1970), 110–113.

    Google Scholar 

  44. Olivecrona, H., Die Parasagittalen Meningeome. Leipzig: Thieme. 1934.

    Google Scholar 

  45. Olsen, L., Frykberg, T., Complications in the treatment of hydrocephalus in children. A comparison of ventriculoatrial and ventriculoperitoneal shunts in a 20-year material. Acta Paediatr. Scand.72 (1983), 385–390.

    PubMed  Google Scholar 

  46. Pennybacker, J. B., Taylor, M., Cairns, H., Penicillin in the prevention of infection during operations on the brain and spinal cord. Lancet2 (1947), 159–162.

    Google Scholar 

  47. Peters, G., Locci, R., Pulverer, G., Adherence and growth of coagulase-negative Staphylococci on surfaces of intravenous catheters. J. Infect. Dis.146 (1982), 479–482.

    PubMed  Google Scholar 

  48. Quadery, L. A., Medlery, A. V., Miles, J., Factors affecting the incidence of wound infection in neurosurgery. Acta Neurochir.39 (Wien) (1977), 133–141.

    Google Scholar 

  49. Rekate, H. L., Ruch, T., Nulsen, F. E., Diphteroid infections of cerebrospinal fluid shunts. J. Neurosurg.52 (1980), 553–556.

    PubMed  Google Scholar 

  50. Savitz, M. H., Malis, B. R., Meyer, B. R., Prophylactic antibiotics in neurosurgery. Surg. Neurol.2 (1974), 95–100.

    PubMed  Google Scholar 

  51. Scarff, T. B., Nelson, P. B., Reigel, D. H., External drainage for ventricular infection following cerebrospinal fluid shunts. Child's Brain4 (1978), 129–136.

    PubMed  Google Scholar 

  52. Schimke, R. T., Black, P. H., Mark, V. H., Swartz, M. N., Indolent Staphylococcus albus or aureus bacteremia after ventriculostomy. New Engl. J. Med.264 (1961), 264–270.

    PubMed  Google Scholar 

  53. Sells, C. J., Shurtleff, D. B., Loeser, J. D., Gram-negative cerebrospinal fluid shunt-associated infections. Pediatrics59 (1977), 614–618.

    PubMed  Google Scholar 

  54. Shurtleff, D. B., Foltz, E. L., Weeks, R. D., Loeser, J., Therapy of Staphylococcus epidermidis: infections associated with cerebrospinal fluid shunts. Pediatrics53 (1974), 55–62.

    PubMed  Google Scholar 

  55. Stauffer, U. G., “Shunt nephritis”: diffuse glomerulonephritis complicating ventriculoatrial shunts. Dev. Med. and Child Neurol.12 Suppl. 22 (1970), 161–164.

    Google Scholar 

  56. Tooth, H. H., The treatment of tumors of the brain, and the indications for operations. Trans. 1st. Cong. Med., London8 (1913), 203–299.

    Google Scholar 

  57. Trexler, P. C., The use of plastics in the design of isolation system. Ann. N. Y. Acad. Sci.78 (1959), 1.

    Google Scholar 

  58. Wang, E. E. L., Prober, C. G., Hendrick, B. E., Hoffman, H. J., Humphrey, B. E., Prophylactic sulfamethoxazole and trimethoprim in ventriculoperitoneal shunt surgery. A doubleblind, randomized, placebo-controlled trial JAMA251 (1984), 1174–1177.

    PubMed  Google Scholar 

  59. Weiss, S. R., Raskind, R., Further experience with the ventriculoperitoneal shunt. Prophylactic antibiotics. Internat. Surg.53 (1970), 300–303.

    Google Scholar 

  60. Woodhall, B., Neill, R. G., Dratz, H. M., Ultraviolet radiation as an adjunct in the control of post-operative neurosurgical infection Ann. Surg.129 (1949), 820–825.

    Google Scholar 

  61. Wright, R. L., A survey of possible etiologic agents in postoperative craniotomy infections. J. Neurosurg.25 (1966), 125–132.

    PubMed  Google Scholar 

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  1. G. C. Blomstedt

    Present address: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland

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    Blomstedt, G.C. Infections in neurosurgery: A retrospective study of 1143 patients and 1517 operations. Acta neurochir 78, 81–90 (1985). https://doi.org/10.1007/BF01808684

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