Telles Joao Paulo Mota, Yamaki Vitor Nagai, Caracante Ricardo Andrade, Martins Victor Hugo Barboza, Paiva Wellingson Silva, Teixeira Manoel Jacobsen, Figueiredo Eberval Gadelha, Neville Iuri Santana
Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
Department of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
Surg Neurol Int. 2022 Jul 1;13:283. doi: 10.25259/SNI_423_2022. eCollection 2022.
There are no guidelines on the management of surgical site infection (SSI) in neurosurgery. This study sought to analyze whether early debridement improved survival compared to antibiotic therapy alone in patients with postcraniotomy infections after oncological neurosurgeries.
We retrospectively reviewed patient records from 2011 to 2019 to identify patients that had been reoperated for the debridement of SSI after brain tumor resection. If SSI was suspected but not clinically evident, the diagnosis was confirmed by cerebrospinal fluid (CSF) analysis or contrast-based imaging examinations. Immediately after diagnosis, broad-spectrum antibiotics were started for all patients.
Out of 81 SSI cases, 57 underwent debridement. Two patients were reoperated 3 times, and three had two surgeries, resulting in a total of 64 procedures. The number of days between SSI diagnosis and surgical intervention did not influence mortality in both univariate and multivariable analyses (Hazard ratio [HR] 1.03, 95% CI 0.93-1.13). Early debridement (<24 h) did not influence rates of antibiotic prescription at discharge ( = 0.53) or hospital length of stay (LOS) ( = 0.16). Higher neutrophil-lymphocyte ratios (NLRs) were associated with the lower survival (HR 1.05, 95% Confidence interval [CI] 1.01-1.08). Multiple cutoffs were tested and values above 3.5 are more significantly associated with worse outcomes (HR 2.2; 95%CI 1.1-4.2).
Early debridement does not seem to influence the survival, rates of antibiotic at discharge, or hospital LOS of patients presenting with SSI after neurosurgery for intracranial tumors. High NLRs are strong predictors of worse prognosis in this population.
目前尚无神经外科手术部位感染（SSI）管理的指南。本研究旨在分析在肿瘤性神经外科手术后开颅感染患者中，早期清创术与单纯抗生素治疗相比是否能提高生存率。
我们回顾性分析了2011年至2019年的患者记录，以确定脑肿瘤切除术后因SSI再次手术进行清创的患者。如果怀疑有SSI但临床未明确，通过脑脊液（CSF）分析或基于造影的影像学检查确诊。确诊后立即对所有患者开始使用广谱抗生素。
在81例SSI病例中，57例接受了清创术。2例患者接受了3次再次手术，3例接受了2次手术，总共进行了64次手术。在单因素和多因素分析中，SSI诊断与手术干预之间的天数均不影响死亡率（风险比[HR] 1.03，95%置信区间[CI] 0.93 - 1.13）。早期清创（<24小时）不影响出院时抗生素处方率（P = 0.53）或住院时间（LOS）（P = 0.16）。较高的中性粒细胞与淋巴细胞比值（NLRs）与较低的生存率相关（HR 1.05，95%置信区间[CI] 1.01 - 1.08）。测试了多个临界值，高于3.5的值与更差的结果更显著相关（HR 2.2；95%CI 1.1 - 4.2）。
早期清创似乎不影响颅内肿瘤神经外科手术后出现SSI患者的生存率、出院时抗生素使用率或住院LOS。高NLRs是该人群预后较差的有力预测指标。
