Department of Neurosurgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea.
Acta Neurochir (Wien). 2013 Nov;155(11):2165-70; discussion 2170. doi: 10.1007/s00701-013-1833-7. Epub 2013 Aug 7.
Surgical site infection (SSI) is one of the most dangerous complications after neurological surgery and is related to additional postoperative hospital days and an increased risk of death. One method for the early detection of SSI, the wound-drain-tip culture (WDC), has been widely used. However, no investigations on the relation between SSIs and wound drains after neurological surgery have been conducted. We performed this study to identify the risk factors for SSIs and to assess the relationship between SSIs and the results of WDC after elective supratentorial craniotomy.
A total of 535 patients underwent elective primary supratentorial craniotomy, and the results of their WDC were analyzed. The mean follow-up period was 14.1 ± 12.2 months. In 347 (64.9 %) patients, the wound drain was removed within 2 days after operation.
Until follow-up, 14 (2.62 %) patients suffered from SSIs. Among the 21 patients with positive WDCs, 8 (38.1 %) patients experienced SSIs. The organisms cultured from the SSIs were matched with the WDC results in 7 (87.5 %) patients. In the multivariate analysis, underweight group (OR = 15.41, p = 0.002), maintenance wound drain over 3 days (OR = 4.202, p = 0.043), and positive WDC (OR = 36.67, p < 0.001) were significantly associated with postoperative SSIs. In 6 (85.7 %) of 7 patients with a positive WDC for Serratia marcescens, SSIs ultimately developed.
The prognostic value of the positive WDC still falls short of our expectations in the field of neurological surgery. And, the positive WDC results should be cautiously interpreted, considering the virulence of the cultured micro-organisms.
外科部位感染（SSI）是神经外科后最危险的并发症之一，与术后住院天数增加和死亡风险增加有关。伤口引流尖端培养（WDC）是早期发现 SSI 的一种方法，已被广泛应用。然而，目前还没有研究报道神经外科手术后 SSI 与伤口引流之间的关系。我们进行这项研究是为了确定 SSI 的危险因素，并评估择期幕上开颅术后 SSI 与 WDC 结果之间的关系。
共 535 例行择期原发性幕上开颅术的患者，分析了他们的 WDC 结果。平均随访时间为 14.1±12.2 个月。在 347 例（64.9%）患者中，伤口引流管在术后 2 天内被移除。
随访期间，14 例（2.62%）患者发生 SSI。在 21 例 WDC 阳性的患者中，有 8 例（38.1%）发生了 SSI。从 SSI 中培养出来的细菌与 WDC 结果相匹配的患者有 7 例（87.5%）。在多变量分析中，体重不足组（OR=15.41，p=0.002）、伤口引流管保留 3 天以上（OR=4.202，p=0.043）和 WDC 阳性（OR=36.67，p<0.001）与术后 SSI 显著相关。在 7 例 WDC 培养出粘质沙雷氏菌的患者中，有 6 例（85.7%）最终发生了 SSI。
在神经外科领域，WDC 的阳性结果的预后价值仍低于我们的预期。而且，考虑到培养微生物的毒力，应谨慎解释 WDC 阳性结果。
