Authors: O SnehArbib A Shiferstein N Dagan S Fein L Telem E Muchtar N EliakimRaz B Rubinovitch G Rubin Z H Rappaport M Paul
Publish Date: 2013/06/11
Volume: 32, Issue: 12, Pages: 1511-1516
Abstract
Neurosurgery is characterized by a prolonged risk period for surgical site infection SSI mainly related to the presence of cerebrospinal fluid CSF drains We aimed to examine factors associated with postneurosurgical SSIs focusing on postoperative factors A prospective cohort study was conducted in a single center over a period of 18 months in Israel Included were adult patients undergoing clean or cleancontaminated craniotomy including craniotomies with external CSF drainage or shunts SSIs were defined by the Centers for Disease Control and Prevention CDC criteria for healthcareassociated infections All patients were followed up for 90 days and those with foreign body insertion for 1 year We compared patients with and without SSI A multivariable regression analysis for SSI was conducted including uncorrelated variables significantly associated with SSI A total of 502 patients were included with 138 275 undergoing emergent or urgent craniotomy The overall SSI rate was 56 28 patients of which 32 16 patients were intracerebral Nonelective surgery external CSF drainage/monitoring devices reoperation and postoperative respiratory failure were independently associated with subsequent SSI External CSF devices was the only significant risk factor for intracerebral SSIs p 0001 Internal shunts or other foreign body insertions were not associated with SSIs A phenotypically identical isolate to that causing the SSI was isolated from respiratory secretions prior to the SSI in 4/9 patients with microbiologically documented intracerebral SSIs Patients with SSIs had longer hospital stay poorer functional capacity on discharge and higher 90day mortality We raise the possibility of postoperative infection acquisition through external CSF devices Standard operating procedures for their maintenance are necessary
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