Meng Ying, Voisin Mathew R, Suppiah Suganth, Merali Zamir, Moghaddamjou Ali, Alotaibi Naif M, Manicat-Emo Arbelle, Weiss Shelly, Go Cristina, McCoy Blathnaid, Donner Elizabeth J, Rutka James T
1Division of Neurosurgery, University of Toronto; and.
3Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.
J Neurosurg Pediatr. 2018 Jul;22(1):31-36. doi: 10.3171/2018.1.PEDS17476. Epub 2018 Apr 6.
OBJECTIVE Intracranial electroencephalography (iEEG) monitoring is an important method of identifying the seizure focus in patients with medically refractory epilepsy. While previous studies have demonstrated low rates of surgical complications, reported rates of surgical site infection (SSI) are highly variable. To date, no studies have specifically evaluated the patient or operative risk factors contributing to SSI. The goals of this study were to examine the rate of SSI after iEEG monitoring for epilepsy workup in pediatric patients and to determine the variables that might contribute to the development of SSI. METHODS A retrospective analysis of hospital charts at the Hospital for Sick Children was performed for all patients who had undergone iEEG monitoring between 2000 and 2016. Univariate and multivariate analyses were performed to look for statistically significant variables in relation to SSI. RESULTS Among 199 patients eligible for analysis, 8 (4.0%) developed SSIs within a period ranging from 21 to 51 days postoperatively. Univariate analysis yielded 4 factors related to SSI: number of people present in the operating room on electrode insertion (p = 0.02), length of insertion surgery (p = 0.04), previous operation at the same surgical site (p = 0.04), and number of depth electrodes inserted (p = 0.01). Multivariate analysis revealed that both the number of people present during the implant operation (OR 0.08, 95% CI 0.01-0.70) and the number of depth electrodes inserted (OR 3.52, 95% CI 1.44-8.59) independently contributed to SSI. CONCLUSIONS This is the largest case series and the first comprehensive review of both patient and operative risk factors in the development of SSI from iEEG monitoring in a pediatric population. The authors' institution had a lower rate of infection than those in most other studies, which could be explained by their protocol of administering intravenous antibiotics perioperatively and post-implant removal antibiotics for 14 days. The authors found a correlation between SSI and the number of people present during the implant operation, as well as the number of depth electrodes; both may contribute to breaks in sterility.
目的 颅内脑电图（iEEG）监测是确定药物难治性癫痫患者癫痫发作灶的重要方法。虽然先前的研究表明手术并发症发生率较低，但报告的手术部位感染（SSI）发生率差异很大。迄今为止，尚无研究专门评估导致SSI的患者或手术风险因素。本研究的目的是检查小儿患者在进行iEEG监测以进行癫痫检查后的SSI发生率，并确定可能导致SSI发生的变量。方法 对2000年至2016年间在病童医院接受iEEG监测的所有患者的医院病历进行回顾性分析。进行单因素和多因素分析以寻找与SSI相关的具有统计学意义的变量。结果 在199例符合分析条件的患者中，8例（4.0%）在术后21至51天内发生了SSI。单因素分析得出与SSI相关的4个因素：电极插入时手术室中的人数（p = 0.02）、插入手术时间（p = 0.04）、同一手术部位先前的手术（p = 0.04）以及插入的深部电极数量（p = 0.01）。多因素分析显示，植入手术期间在场的人数（OR 0.08，95% CI 0.01 - 0.70）和插入的深部电极数量（OR 3.52，95% CI 1.44 - 8.59）均独立导致SSI。结论 这是最大的病例系列，也是首次对小儿人群iEEG监测中SSI发生的患者和手术风险因素进行的全面综述。作者所在机构的感染率低于大多数其他研究，这可能是由于他们围手术期静脉使用抗生素以及植入后拔除电极后使用抗生素14天的方案所致。作者发现SSI与植入手术期间在场的人数以及深部电极数量之间存在相关性；两者都可能导致无菌操作的中断。
