Risk factors for surgical site infections after neurosurgery: A focus on the postoperative period

doi:10.1016/j.ajic.2015.07.005

American Journal of Infection Control

Volume 43, Issue 12, 1 December 2015, Pages 1288-1291

https://doi.org/10.1016/j.ajic.2015.07.005 Get rights and content

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.

Section snippets

Materials and methods

We conducted a prospective cohort study of SSI among adult neurosurgical patients at the 694-bed, University Nord Hospital in Marseille (France). All patients undergoing neurosurgical procedure (brain or spine surgery) from January 1, 2009-December 31, 2010, were eligible for inclusion. We excluded patients already diagnosed with an SSI, patients with open skull fracture, and those for whom the follow-up was incomplete. A neurosurgeon and a member of the infection control team systematically

Results

A total of 949 neurosurgical patients were prospectively included during a 24-month period. Their age ranged from 18-90 years (mean ± SD, 55.9 ± 18 years); 533 (56.5%) of them were men. The procedures were divided into cranial surgery (n = 526; 55.4%) and spinal surgery (n = 423; 44.6%). The general combined SSI rate was 4.5% (43 SSIs), corresponding primarily to deep or organ-space SSI (n = 37; 86%). It was divided into 25 SSIs (4.7%) for cranial surgery and 18 SSIs (4.2%) for spinal surgery.

Discussion

In this study we observed a significant decrease of the SSI incidence rate during a 2-year surveillance period. Implementation of an active surveillance with quarterly feedback to the surgical staff may have contributed to it.¹³ As noted by Heipel et al, active surveillance by an infection control practitioner together with neurosurgeons may enhance significantly the sensitivity for detecting SSI.¹⁴ Moreover, in a French national-based surveillance program, the SSI rate decrease was associated

Conclusion

Effective infection control programs should include an adequate number of trained infection control staff and a system for sustained reporting of SSI rates to surgeons. Infection control measures during the postoperative period represent a window of opportunity to improve the management of neurosurgical patients and to decrease their incidence of SSI.

Acknowledgment

We thank Yves Seccia for his technical assistance.

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Surgical site infections (SSIs) postcraniotomy continue to impose a significant burden on health care systems and patient outcomes. It is, therefore, important to understand their risk factors in order to promote effective preventative measures. This meta-analysis aims to provide a comprehensive, up-to-date analysis of the risk factors associated with SSIs in neurosurgical procedures.
A systematic review was conducted as per preferred reporting items for systematic reviews and meta-analysis guidelines to explore existing primary evidence on the risk factors for SSIs postcraniotomy. A comprehensive search of MEDLINE, EMBASE, and Pubmed was performed from database inception up to June 2023. 43 studies were included in the meta-analysis, encompassing a total of 68,881 patients.
The strongest predictor for SSIs was found to be cerebrospinal fluid (CSF) leak (OR: 8.91, CI: 4.30-18.44). Other significant factors included infratentorial surgery (OR: 0.43, CI: 0.31-0.61), emergency surgery (OR: 1.41, CI: 1.05-1.91), reintervention (OR: 3.19, CI: 1.77-5.75), prolonged operative time (mean difference: 33.25; CI: 18.83-47.67), hospital length of stay (mean difference: 0.60; CI: 0.23-0.98) and intracranial pressure monitor (ICPM) insertion (OR: 1.81; CI: 1.06-3.11). Contrarily, sex, body mass index (BMI), diabetes, antibiotic prophylaxis, immunosuppressive agents, trauma, use of artificial implants did not demonstrate statistical significance.
This meta-analysis provides an up-to-date and comprehensive evaluation of risk factors for SSIs postcraniotomy. It emphasizes the need for preventive strategies, particularly against CSF leaks, and calls for further research to elucidate the intricate relationships between these factors.
Assessment of the impact of frailty on adverse surgical outcomes in patients undergoing surgery for intracranial tumors using modified frailty index: A systematic review and meta-analysis
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Modified frailty index (MFI) is an emerging quantitative measure of frailty; however, the quantified risk of adverse outcomes in surgeries for intracranial tumors associated with increasing MFI scores has not been thoroughly reviewed in a comprehensive manner.
MEDLINE (PubMed), Scopus, Web of Science, and Embase were searched to identify observational studies on the association between 5 and 11 item-modified frailty index (MFI) and perioperative outcomes for neurosurgical procedures including complications, mortality, readmission, and reoperation rate. Primary analysis pooled all comparisons with MFI scores greater than or equal to 1 versus non-frail participants using mixed-effects multilevel model for each outcome.
In total, 24 studies were included in the review and 19 studies with 114,707 surgical operations were included in the meta-analysis. While increasing MFI scores were associated with worse prognosis for all included outcomes, reoperation rate was only significantly higher in patients with MFI ≥ 3. Among surgical pathologies, glioblastoma was influenced by a greater extent to the impact of frailty on complications and mortality that most other etiologies. In agreement with qualitative evaluation of the included studies, meta-regression did not reveal association between mean age of the comparisons and complications rate.
The results of this meta-analysis provides quantitative risk assessment of adverse outcomes in neuro-oncological surgeries with increased frailty. The majority of literature suggests that MFI is a superior and independent predictor of adverse outcomes compared to age.
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Despite its efficacy and minimal invasiveness, the clean-contaminated nature of endoscopic transnasal surgery (ETS) may be susceptible to central nervous system surgical site infections (CNS-SSIs), especially when involving intradural exposure. However, the profiles of ETS-associated CNS-SSIs are not fully elucidated.
The institutional ETS cases performed between May 2017 and March 2023 were retrospectively analysed. The incidences of CNS-SSIs were calculated, and their risk factors examined.
The incidence of CNS-SSIs was 2.3% (7/305) in the entire cohort and 5.0% (7/140) in ETSs with intradural exposure. All the CNS-SSIs were meningitis and developed following ETS with intradural exposure. The incidences were 0%, 5.6% and 5.8% in ETSs with Esposito grade 1, 2 and 3 intraoperative cerebrospinal fluid leakage, respectively. Among the pre- and intra-operative factors, body mass index (unit odds ratio (OR), 0.62; 95% confidence interval (CI), 0.44–0.89; P<0.01), serum albumin (unit OR, 0.03; 95% CI, 0.0007–0.92; P=0.02), and American Society of Anesthesiologists physical status score (unit OR, 20.7; 95% CI, 1.65–259; P<0.01) were significantly associated with CNS-SSIs. Moreover, postoperative cerebrospinal fluid leakage was also significantly associated with CNS-SSIs (OR, 18.4; 95% CI, 3.55–95.0; P<0.01).
The incidence of ETS-associated CNS-SSIs is acceptably low. Intradural exposure was a prerequisite for CNS-SSIs. Malnutrition and poor comorbidity status should be recognized as important risks for CNS-SSIs in ETS.
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Orthopaedic surgical site infections (SSIs) are among the most important and prevalent because implanted devices are used in such surgeries which increase the risk of infection. This study aimed to examine the incidence of infection in orthopaedic surgeries and related factors in a group of public hospitals in Iran.
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Of 110 included patients undergoing orthopaedic surgeries, 18.2% had an infection. The highest rate of infection was associated with lower extremity surgeries following tibia and fibula fractures. The incidence of infection among individuals under the age of 35 years was also higher. Emergency procedures demonstrated a higher incidence of infection. No significant relationship was observed between use of wound drains and development of SSIs.
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Owing to prolonged hospitalization and the complexity of care required for patients with aneurysmal subarachnoid hemorrhage (aSAH), these patients have a high risk of complications. The risk for wound infection after microsurgical treatment for aSAH was analyzed.
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: Conflicts of interest: None to report.

¹: These authors contributed equally to this work.

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Major articleRisk factors for surgical site infections after neurosurgery: A focus on the postoperative period

Background

Methods

Results

Conclusion

Section snippets

Materials and methods

Results

Discussion

Conclusion

Acknowledgment

J Hosp Infect

Am J Infect Control

Infect Dis Clin North Am

Am J Infect Control

J Hosp Infect

Am J Infect Control

J Hosp Infect

Clin Microbiol Infect

Lancet

Am J Infect Control

J Clin Neurosci

J Hosp Infect

Clin Neurol Neurosurg

The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs

Infect Control Hosp Epidemiol

Strategies to prevent surgical site infections in acute care hospitals: 2014 update

Infect Control Hosp Epidemiol

Major article
Risk factors for surgical site infections after neurosurgery: A focus on the postoperative period