Risk factors for surgical site infection after craniotomy: a prospective cohort study

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Abstract

Background

Although surgical site infection after craniotomy (SSI-CRAN) is a serious complication, risk factors for its development have not been well defined. We aim to identify the risk factors for developing SSI-CRAN in a large prospective cohort of adult patients undergoing craniotomy.

Methods

A series of consecutive patients who underwent craniotomy at a university hospital from January 2013 to December 2015 were prospectively assessed. Demographic, epidemiological, surgical, clinical and microbiological data were collected. Patients were followed up in an active post-discharge surveillance programm e for up to one year after surgery. Multivariate analysis was carried out to identify independent risk factors for SSI-CRAN.

Results

Among the 595 patients who underwent craniotomy, 91 (15.3%) episodes of SSI-CRAN were recorded, 67 (73.6%) of which were organ/space. Baseline demographic characteristics were similar among patients who developed SSI-CRAN and those who did not. The most frequent causative Gram-positive organisms were Cutibacterium acnes (23.1%) and Staphylococcus epidermidis (23.1%), whereas Enterobacter cloacae (12.1%) was the most commonly isolated Gram-negative agent. In the univariate analysis the factors associated with SSI-CRAN were ASA score > 2 (48.4% vs. 35.5% in SSI-CRAN and no SSI-CRAN respectively, p = 0.025), extrinsic tumour (28.6% vs. 19.2%, p = 0.05), and re-intervention (4.4% vs. 1.4%, p = < 0.001). In the multivariate analysis, ASA score > 2 (AOR: 2.26, 95% CI: 1.32–3.87; p = .003) and re-intervention (OR: 8.93, 95% CI: 5.33–14.96; p < 0.001) were the only factors independently associated with SSI-CRAN.

Conclusion

The risk factors and causative agents of SSI-CRAN identified in this study should be considered in the design of preventive strategies aimed to reduce the incidence of this serious complication.

Electronic supplementary material

The online version of this article (10.1186/s13756-019-0525-3) contains supplementary material, which is available to authorized users.

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Most cited references 32

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Surgical site infection (SSI) rates in the United States, 1992-1998: the National Nosocomial Infections Surveillance System basic SSI risk index.

R P Gaynes, D H Culver, T C Horan … (2001)

By use of the National Nosocomial Infections Surveillance (NNIS) System's surgical patient surveillance component protocol, the NNIS basic risk index was examined to predict the risk of a surgical site infection (SSI). The NNIS basic SSI risk index is composed of the following criteria: American Society of Anesthesiologists score of 3, 4, or 5; wound class; and duration of surgery. The effect when a laparoscope was used was also determined. Overall, for 34 of the 44 NNIS procedure categories, SSI rates increased significantly (P< .05) with the number of risk factors present. With regard to cholecystectomy and colon surgery, the SSI rate was significantly lower when the procedure was done laparoscopically within each risk index category. With regard to appendectomy and gastric surgery, use of a laparoscope affected SSI rates only when no other risk factors were present. The NNIS basic SSI index is useful for risk adjustment for a wide variety of procedures. For 4 operations, the use of a laparoscope lowered SSI risk, requiring modification of the NNIS basic SSI risk index.

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Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study.

C Wloch, J Wilson, T Lamagni … (2012)

To assess the frequency and risk factors for surgical site infection following caesarean section.

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Surgical site infections: reanalysis of risk factors.

Debra L Malone, Thomas Genuit, J Kathleen Tracy … (2002)

Surgical site infections (SSI) are the most common nosocomial infection in surgical patients, accounting for 38% of all such infections, and are a significant source of postoperative morbidity resulting in increased hospital length of stay and increased cost. During 1986-1996 the Center for Disease Control and Prevention's National Nosocomial Infections Surveillance system reported 15,523 SSI following 593,344 operations (2.6%). Previous studies have documented patient characteristics associated with an increased risk of SSI, including diabetes, tobacco or steroid use, obesity, malnutrition, and perioperative blood transfusion. In this study we sought to reevaluate risk factors for SSI in a large cohort of noncardiac surgical patients. Prospective data (NSQIP) were collected on 5031 noncardiac surgical patients at the Veteran's Administration Maryland Healthcare System from 1995 to 2000. All preoperative risk factors were evaluated as independent predictors of surgical site infection. The mean age of the study cohort was 61 plus minus 13. SSI occurred in 162 patients, comprising 3.2% of the study cohort. Gram-positive organisms were the most common bacterial etiology. Multiple logistic regression analysis documented that diabetes (insulin- and non-insulin-dependent), low postoperative hematocrit, weight loss (within 6 months), and ascites were significantly associated with increased SSI. Tobacco use, steroid use, and chronic obstructive pulmonary disease (COPD) were not predictors for SSI. This study confirms that diabetes and malnutrition (defined as significant weight loss 6 months prior to surgery) are significant preoperative risk factors for SSI. Postoperative anemia is a significant risk factor for SSI. In contrast to prior analyses, this study has documented that tobacco use, steroid use, and COPD are not independent predictors of SSI. Future SSI studies should target early preoperative intervention and optimization of patients with diabetes and malnutrition.

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Author and article information

Contributors

Emilio Jiménez-Martínez: e.jimenez@bellvitgehospital.cat

Guillermo Cuervo: 34-932607625 , guillermo.cuervo@bellvitgehospital.cat

Ana Hornero: chornero@bellvitgehospital.cat

Pilar Ciercoles: pciercoles@bellvitgehospital.cat

Andres Gabarrós: agabarros@bellvitgehospital.cat

Carmen Cabellos: ccabellos@bellvitgehospital.cat

Ivan Pelegrin: ivan_pelegrin@hotmail.com

Dolores García-Somoza: dsomoza@bellvitgehospital.cat

Jordi Adamuz: jadamuz@bellvitgehospital.cat

Jordi Carratalà: jcarratala@bellvitgehospital.cat

Miquel Pujol: mpujol@bellvitgehospital.cat

Journal

Journal ID (nlm-ta): Antimicrob Resist Infect Control

Journal ID (iso-abbrev): Antimicrob Resist Infect Control

Title: Antimicrobial Resistance and Infection Control

Publisher: BioMed Central (London )

ISSN (Electronic): 2047-2994

Publication date (Electronic): 2 May 2019

Publication date PMC-release: 2 May 2019

Publication date Collection: 2019

Volume: 8

Electronic Location Identifier: 69

Affiliations

[1 ]ISNI 0000 0000 8836 0780, GRID grid.411129.e, Infectious Diseases Department, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), , Bellvitge University Hospital, ; Feixa Llarga s/n, 08907, L’Hospitalet de Llobregat, Barcelona, Spain

[2 ]ISNI 0000 0004 0427 2257, GRID grid.418284.3, Neurosurgery Department, , Bellvitge University Hospital-Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), ; Barcelona, Spain

[3 ]Infectious Diseases Department, H. Parc Taulí, Sabadell, Spain

[4 ]ISNI 0000 0004 0427 2257, GRID grid.418284.3, Microbiology Department, , Bellvitge University Hospital-Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), ; Barcelona, Spain

[5 ]ISNI 0000 0004 0427 2257, GRID grid.418284.3, Nursing Information Systems Department Support, , Bellvitge University Hospital-Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), ; Barcelona, Spain

[6 ]ISNI 0000 0004 1937 0247, GRID grid.5841.8, University of Barcelona, ; Barcelona, Spain

Article

Publisher ID: 525

DOI: 10.1186/s13756-019-0525-3

PMC ID: 6498621

PubMed ID: 31073400

SO-VID: 9816f66e-04a9-4166-ad17-61bcaf704264

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.