Background
Surgical site infection (SSI) after neurosurgery has potentially devastating consequences.
Methods
A prospective cohort study was conducted over a period of 24 months in a university
center. All adult patients undergoing neurosurgical procedures, with exception of
open skull fractures, were included. Multivariate logistic regression analysis was
used to identify independent risk factors.
Results
We included 949 patients. Among them, 43 were diagnosed with SSI (4.5%). A significant
reduction in postneurosurgical SSI from 5.8% in 2009 to 3.0% in 2010 (P = .04) was observed. During that period, an active surveillance with regular feedback
was established. The most common microorganisms isolated from SSI were Staphylococcus aureus (23%), Enterobacteriaceae (21%), and Propionibacterium acnes (12%). We identified the following independent risk factors for SSI postcranial surgery:
intensive care unit (ICU) length of stay ≥7 days (odds ratio [OR] = 6.1; 95% confidence
interval [CI], 1.7-21.7), duration of drainage ≥3 days (OR = 3.3; 95% CI, 1.1-11),
and cerebrospinal fluid leakage (OR = 5.6; 95% CI, 1.1-30). For SSIs postspinal surgery,
we identified the following: ICU length of stay ≥7 days (OR = 7.2; 95% CI, 1.6-32.1),
coinfection (OR = 9.9; 95% CI, 2.2-43.4), and duration of drainage ≥3 days (OR = 5.7;
95% CI, 1.5-22).
Conclusion
Active surveillance with regular feedback proved effective in reducing SSI rates.
The postoperative period is associated with overlooked risk factors for neurosurgical
SSI. Infection control measures targeting this period are therefore promising.
Key Words
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Article info
Publication history
Published online: August 20, 2015
Footnotes
Conflicts of interest: None to report.
Identification
Copyright
© 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
