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59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

01. - 04.06.2008, Würzburg

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Surgical Site Infections (SSIs) after elective neurosurgery: results of a prospective clinical study on 3394 consecutive operations

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  • corresponding author L. Valentini - Department of Neurosurgery, Istituto Nazionale Neurologico Carlo Besta (INNCB), Milan, Italy
  • C. L. Solero - Department of Neurosurgery, Istituto Nazionale Neurologico Carlo Besta (INNCB), Milan, Italy
  • S. Giombini
  • C. Casali - Department of Neurosurgery, Istituto Nazionale Neurologico Carlo Besta (INNCB), Milan, Italy
  • F. Legnani - Department of Neurosurgery, Istituto Nazionale Neurologico Carlo Besta (INNCB), Milan, Italy
  • S. Visintini - Department of Neurosurgery, Istituto Nazionale Neurologico Carlo Besta (INNCB), Milan, Italy
  • C. Uberti-Foppa - Department of Neurosurgery, Istituto Nazionale Neurologico Carlo Besta (INNCB), Milan, Italy
  • G. Broggi - Department of Neurosurgery, Istituto Nazionale Neurologico Carlo Besta (INNCB), Milan, Italy

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocDI.08.02

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2008/08dgnc198.shtml

Veröffentlicht: 30. Mai 2008

© 2008 Valentini et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.

Gliederung

Text

Objective: To evaluate the incidence and the risk factors for post-surgical site infections (SSIs) in elective neurosurgical procedures, uniformly treated with an ultra-short antibiotic protocol and to evaluate the efficacy of the protocol over the years.

Methods: The series of 5701 consecutive elective neurosurgical procedures performed from July 2005 till July 2007 at INNCB of Milan were submitted to an ultra-short prophylactic antibiotic therapy (ABP) according to three different risk classes (Clean, Clean Contaminated and Shunt). The ABP was prolonged to treat any early infectious signs and in every case of external communication, such as CSF leaks or external-drainages. The case mix included high-risk complex craniotomies performed for tumour removal In more than half of the cases. The risk factors analyzed were: patients age, gender, ASA, BMI; type and duration of surgery and implanted devices, recurrences, operating room, disinfection procedures, neurological outcome and GCS, invasive presidia applied, duration of intensive care, systemic perioperative infections and CSF leakage, drainage or evacuated collections.

Results: The SSIs (Surgical Site Infections) were registered and the infection rate due to surgery was found to be less than 2%. An increased incidence was observed in longer surgeries, reoperations for glioma and implants of CNS stimulators. CSF leakage was the most important cause of SSIs, while the neurological deterioration due to postoperative complications correlated with systemic infections.

Conclusions: In a previous study at the same Institute, we concluded that the protocol seemed quite appropriate to the case mix, due to the low incidence of SSIs (0.6%); the study was extended to better evaluate risk factors and the “duration of efficacy” of the protocol over the years. The rate of SSIs remained low, but we observed a change in the pattern of infections, with a higher percentage of gram negative bacteria. The prolongation of the antibiotic therapy lost its efficacy on systemic infections.