Zanaty Mario, Chalouhi Nohra, Starke Robert M, Chitale Rohan, Hann Shannon, Bovenzi Cory D, Saigh Mark P, Schwartz Eric W, Kunkel Emily S I, Efthimiadis-Budike Alexandra S, Jabbour Pascal, Dalyai Richard, Rosenwasser Robert H, Tjoumakaris Stavropoula I
Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University Hospital, Thomas Jefferson University, 901 Walnut Street, 3rd Floor, Philadelphia, PA 19107, USA.
Department of Neurological Surgery, University of Virginia, Charlottesville, VA 22908, USA.
ScientificWorldJournal. 2014;2014:356042. doi: 10.1155/2014/356042. Epub 2014 Oct 22.
The variables that predispose to postcranioplasty infections are poorly described in the literature. We formulated a multivariate model that predicts the risk of infection in patients undergoing cranioplasty.
Retrospective review of all patients who underwent cranioplasty following craniectomy from January, 2000, to December, 2011. Tested predictors were age, sex, diabetic status, hypertensive status, reason for craniectomy, urgency status of craniectomy, location of cranioplasty, reoperation for hematoma, hydrocephalus postcranioplasty, and material type. A multivariate logistic regression analysis was performed.
Three hundred forty-eight patients met the study criteria. Infection rate was 26.43% (92/348). Of these cases with infection, 56.52% (52/92) were superficial (supragaleal), 43.48% (40/92) were deep (subgaleal), and 31.52% (29/92) were present in both the supragaleal and subgaleal spaces. The predominant pathogen was coagulase-negative staphylococcus (30.43%) followed by methicillin-resistant Staphylococcus aureus (22.83%) and methicillin-sensitive Staphylococcus aureus (15.22%). Approximately 15.22% of all cultures were polymicrobial. Multivariate analysis revealed convex craniectomy, hemorrhagic stroke, and hydrocephalus to be associated with an increased risk of infection (OR = 14.41; P < 0.05, OR = 4.33; P < 0.05, OR = 1.90; P = 0.054, resp.).
Many of the risk factors for infection after cranioplasty are modifiable. Recognition and prevention of the risk factors would help decrease the infection's rate.
文献中对颅骨修补术后感染的易感因素描述甚少。我们构建了一个多变量模型来预测颅骨修补术患者的感染风险。
回顾性分析2000年1月至2011年12月期间所有颅骨切除术后接受颅骨修补术的患者。检测的预测因素包括年龄、性别、糖尿病状态、高血压状态、颅骨切除原因、颅骨切除的紧急程度、颅骨修补位置、血肿再次手术、颅骨修补术后脑积水以及材料类型。进行多变量逻辑回归分析。
348例患者符合研究标准。感染率为26.43%（92/348）。在这些感染病例中，56.52%（52/92）为表浅（帽状腱膜上）感染，43.48%（40/92）为深部（帽状腱膜下）感染，31.52%（29/92）在帽状腱膜上和帽状腱膜下间隙均有感染。主要病原体为凝固酶阴性葡萄球菌（30.43%），其次是耐甲氧西林金黄色葡萄球菌（22.83%）和甲氧西林敏感金黄色葡萄球菌（15.22%）。所有培养物中约15.22%为混合菌感染。多变量分析显示凸面颅骨切除、出血性中风和脑积水与感染风险增加相关（OR分别为14.41；P<0.05，OR为4.33；P<0.05，OR为1.90；P = 0.054）。
颅骨修补术后感染的许多风险因素是可以改变的。识别和预防这些风险因素有助于降低感染率。
