Chidambaram Swathi, Vasudevan Madabushi Chakravarthy, Nair Mani Nathan, Joyce Cara, Germanwala Anand V
Department of Neurosurgery, Loyola University Medical Center, Maywood, Illinois, USA.
Postgraduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, Voluntary Health Services Hospital, Chennai, India.
World Neurosurg. 2018 Feb;110:e239-e244. doi: 10.1016/j.wneu.2017.10.142. Epub 2017 Nov 22.
Postoperative central nervous system infections (PCNSIs) are serious complications following neurosurgical intervention. We previously investigated the incidence and causative pathogens of PCNSIs at a resource-limited, neurosurgical center in south Asia. This follow-up study was conducted to analyze differences in PCNSIs at the same institution following only one apparent change: the operating room air filtration system.
This was a retrospective study of all neurosurgical cases performed between December 1, 2013, and March 31, 2016 at our center. Providers, patient demographic data, case types, perioperative care, rate of PCNSI, and rates of other complications were reviewed. These results were then compared with the findings of our previous study of neurosurgical cases between June 1, 2012, and June 30, 2013.
All 623 neurosurgical operative cases over the study period were reviewed. Four patients (0.6%) had a PCNSI, and no patients had a positive cerebrospinal fluid (CSF) culture. In the previous study, among 363 cases, 71 patients (19.6%) had a PCNSI and 7 (1.9%) had a positive CSF culture (all Gram-negative organisms). The differences in both parameters are statistically significant (P < 0.001). Between the 2 studies, there was no change in treatment providers, case types, case durations, antibiotic administration practices, and patient demographics.
The rates of PCNSI and positive CSF culture were significantly lower in our present cohort compared with the cohort in our previous study. The sole apparent change involves the air filtration system inside the neurosurgical operating rooms; this environmental change occurred during the 5 months between the 2 studies. This study demonstrates the impact of environmental factors in reducing infections.
术后中枢神经系统感染（PCNSIs）是神经外科手术后的严重并发症。我们之前在南亚一个资源有限的神经外科中心调查了PCNSIs的发病率和致病病原体。本随访研究旨在分析同一机构中PCNSIs的差异，仅发生了一个明显变化：手术室空气过滤系统。
这是一项对2013年12月1日至2016年3月31日在我们中心进行的所有神经外科病例的回顾性研究。回顾了医疗人员、患者人口统计学数据、病例类型、围手术期护理、PCNSI发生率以及其他并发症发生率。然后将这些结果与我们之前对2012年6月1日至2013年6月30日神经外科病例的研究结果进行比较。
对研究期间的所有623例神经外科手术病例进行了回顾。4例患者（0.6%）发生了PCNSI，且没有患者脑脊液（CSF）培养呈阳性。在之前的研究中，363例病例中有71例患者（19.6%）发生了PCNSI，7例（1.9%）患者CSF培养呈阳性（均为革兰氏阴性菌）。这两个参数的差异具有统计学意义（P < 0.001）。在这两项研究之间，治疗医疗人员、病例类型、病例持续时间、抗生素使用情况和患者人口统计学特征均无变化。
与我们之前研究中的队列相比，我们当前队列中的PCNSI发生率和CSF培养阳性率显著降低。唯一明显的变化涉及神经外科手术室内的空气过滤系统；这种环境变化发生在两项研究之间的5个月内。本研究证明了环境因素在减少感染方面的作用。
