Surgical site infection associated with the use of bovine serum albumine-glutaraldehyde surgical adhesive (BioGlueA®) in cranial surgery: a case-control study

To enhance the water tightness of dura mater closure in cranial surgery, an organic glue called BioGlueA (R) was used in our neurosurgical department between January 2006 and June 2007. During this period of time, we noticed an important increase in the surgical site infection (SSI) incidence. We conducted a case-control study to identify risk factors for these infections. Our objective was to test the hypothesis that BioGlueA (R) was one of the risk factors. Cases with infection were defined retrospectively. We included two controls per case. Study data were age, sex, time of year, in stay hospital preoperative time, length of surgery, type of surgery, surgeon, use of BioGlueA (R), and use of duraplasty. We first performed a univariate analysis and then the significant variables were introduced in a logistic regression model. Thirty patients were defined as cases (60 controls). In multivariate analysis, risk factors were young age (p = 0.04), extended operative length (p = 0.02) and the use of BioGlue (p = 0.007). The combined use of BioGlueA (R) and NeuropatchA (R) appeared to be a significant risk factor for SSI (p = 0.002). BioGlueA (R) seems to increase the risk of SSI for patients who underwent craniotomy, especially when associated with synthetic dural graft. BioGlueA (R) triggers an intense inflammatory response, which causes wound breaches allowing bacteria to spread down in the wound, and then creates an ideal environment for bacterial growth.