Surgical site infections following craniotomy focusing on possible post-operative acquisition of infection: prospective cohort study

被引:48
作者
Sneh-Arbib, O. [1 ]
Shiferstein, A. [1 ]
Dagan, N. [1 ]
Fein, S. [2 ]
Telem, L. [3 ]
Muchtar, E. [4 ]
Eliakim-Raz, N. [4 ]
Rubinovitch, B. [5 ]
Rubin, G. [3 ]
Rappaport, Z. H. [3 ,6 ]
Paul, M. [1 ,6 ]
机构
[1] Beilinson Med Ctr, Rabin Med Ctr, Infect Dis Unit, Petah Tiqwa, Israel
[2] Beilinson Med Ctr, Rabin Med Ctr, Dept Anesthesia, Petah Tiqwa, Israel
[3] Beilinson Med Ctr, Rabin Med Ctr, Dept Neurosurg, Petah Tiqwa, Israel
[4] Beilinson Med Ctr, Rabin Med Ctr, Petah Tiqwa, Israel
[5] Beilinson Med Ctr, Rabin Med Ctr, Unit Infect Control, Petah Tiqwa, Israel
[6] Tel Aviv Univ, Sackler Fac Med, Ramat Aviv, Israel
关键词
RISK-FACTORS; ANTIBIOTIC-PROPHYLAXIS; MENINGITIS; NEUROSURGERY; MANAGEMENT; MORTALITY;
D O I
10.1007/s10096-013-1904-y
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Neurosurgery is characterized by a prolonged risk period for surgical site infection (SSI), mainly related to the presence of cerebrospinal fluid (CSF) drains. We aimed to examine factors associated with post-neurosurgical SSIs, focusing on post-operative factors. A prospective cohort study was conducted in a single center over a period of 18 months in Israel. Included were adult patients undergoing clean or clean-contaminated craniotomy, including craniotomies with external CSF drainage or shunts. SSIs were defined by the Centers for Disease Control and Prevention (CDC) criteria for healthcare-associated infections. All patients were followed up for 90 days and those with foreign body insertion for 1 year. We compared patients with and without SSI. A multivariable regression analysis for SSI was conducted including uncorrelated variables significantly associated with SSI. A total of 502 patients were included, with 138 (27.5 %) undergoing emergent or urgent craniotomy. The overall SSI rate was 5.6 % (28 patients), of which 3.2 % (16 patients) were intracerebral. Non-elective surgery, external CSF drainage/monitoring devices, re-operation, and post-operative respiratory failure were independently associated with subsequent SSI. External CSF devices was the only significant risk factor for intracerebral SSIs (p < 0.001). Internal shunts or other foreign body insertions were not associated with SSIs. A phenotypically identical isolate to that causing the SSI was isolated from respiratory secretions prior to the SSI in 4/9 patients with microbiologically documented intracerebral SSIs. Patients with SSIs had longer hospital stay, poorer functional capacity on discharge, and higher 90-day mortality. We raise the possibility of post-operative infection acquisition through external CSF devices. Standard operating procedures for their maintenance are necessary.
引用
收藏
页码:1511 / 1516
页数:6
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