Krafft Paul R, Agoris Corin P, Tran Quan D, Amer Aboubakr, Alhazaimeh Mohammad, Dutta Mudit, Weisman Sydney, Alikhani Puya, Tran Nam D
Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa, FL, USA.
Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Clin Neurol Neurosurg. 2022 Apr;215:107206. doi: 10.1016/j.clineuro.2022.107206. Epub 2022 Mar 10.
Craniotomies for resection of neoplastic lesions are at increased risk for surgical site infections (SSIs) as compared to non-neoplastic pathologies. SSIs can be detrimental due to delay in pivotal adjuvant therapies.
The purpose of this study was to determine the rate of SSI in primary brain tumors, to analyze risk factors, and to evaluate effectiveness of topical vancomycin in reducing SSIs.
A retrospective cohort study was conducted at a National Cancer Institutedesignated Comprehensive Cancer Center. Patients with primary brain tumors (n = 799) who were subjected to craniotomy from 2004 to 2014 were included. Patient demographics, tumor characteristics, use of topical vancomycin and clinical outcomes were analyzed.
Topical vancomycin was associated with a significantly lower rate of SSI (0.8%) compared to standard care (5%), ( p = 0.00071; OR = 0.15; 95% CI = 0.02 - 0.5). Narcotic use ( p = 0.043; OR = 2.24; 95% CI = 0.96 - 4.81), previous brain radiation ( p = 0.043; OR = 2.08; 95% CI = 1.02 - 4.29), length of hospitalization ( p = 0.01; OR= 1.04; 95% CI = 1.01 - 1.08), and 30 day re-operation ( p = 1.58 ×10 -10; OR = 15.23; 95% CI = 7.06 - 32.71) were associated with increased risk for SSI.
Topical vancomycin effectively reduced the rate of SSI in patients subjected to craniotomy for primary brain tumor resection. Furthermore, preoperative narcotic use, previous head/brain radiation, length of hospitalization, and 30-day reoperation were associated with increased risk of SSI.
与非肿瘤性病变相比，因切除肿瘤性病变而进行开颅手术的患者发生手术部位感染（SSI）的风险更高。由于关键辅助治疗的延迟，SSI可能是有害的。
本研究的目的是确定原发性脑肿瘤中SSI的发生率，分析危险因素，并评估局部应用万古霉素在降低SSI方面的有效性。
在一家美国国立癌症研究所指定的综合癌症中心进行了一项回顾性队列研究。纳入了2004年至2014年期间接受开颅手术的原发性脑肿瘤患者（n = 799）。分析了患者的人口统计学特征、肿瘤特征、局部应用万古霉素的情况以及临床结局。
与标准治疗（5%）相比，局部应用万古霉素的SSI发生率显著较低（0.8%），（p = 0.00071；OR = 0.15；95%CI = 0.02 - 0.5）。使用麻醉剂（p = 0.043；OR = 2.24；95%CI = 0.96 - 4.81）、既往脑部放疗（p = 0.043；OR = 2.08；95%CI = 1.02 - 4.29）、住院时间（p = 0.01；OR = 1.04；95%CI = 1.01 - 1.08）和30天再次手术（p = 1.58×10 -10；OR = 15.23；95%CI = 7.06 - 32.71）与SSI风险增加相关。
局部应用万古霉素有效降低了因原发性脑肿瘤切除而接受开颅手术患者的SSI发生率。此外，术前使用麻醉剂、既往头部/脑部放疗、住院时间和30天再次手术与SSI风险增加相关。
