Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
Eur J Clin Microbiol Infect Dis. 2013 Dec;32(12):1511-6. doi: 10.1007/s10096-013-1904-y. Epub 2013 Jun 11.
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.
神经外科的手术部位感染（SSI）风险期较长，主要与存在脑脊液（CSF）引流管有关。我们旨在研究与神经外科术后 SSI 相关的因素，重点关注术后因素。这项前瞻性队列研究在以色列的一家中心进行，时间跨度为 18 个月。纳入的患者为行清洁或清洁污染性开颅术的成年患者，包括有外部 CSF 引流或分流器的开颅术。SSI 根据疾病预防控制中心（CDC）关于医疗保健相关感染的标准进行定义。所有患者均随访 90 天，有异物植入的患者随访 1 年。我们比较了有 SSI 和无 SSI 的患者。对 SSI 进行了多变量回归分析，包括与 SSI 显著相关的无关联变量。共纳入 502 例患者，其中 138 例（27.5%）行紧急或紧急开颅术。总的 SSI 发生率为 5.6%（28 例），其中 3.2%（16 例）为脑内。非择期手术、外部 CSF 引流/监测装置、再次手术和术后呼吸衰竭与随后的 SSI 独立相关。外部 CSF 装置是唯一与脑内 SSI 显著相关的危险因素（p < 0.001）。内部分流器或其他异物植入物与 SSI 无关。在 9 例微生物学确诊的脑内 SSI 患者中，有 4 例在 SSI 发生前从呼吸道分泌物中分离出与 SSI 相同的表型的分离株。发生 SSI 的患者住院时间更长，出院时的功能状态更差，90 天死亡率更高。我们提出通过外部 CSF 装置获得术后感染的可能性。需要制定这些设备维护的标准操作规程。
