Article
Risk factors for surgical site infections in neurosurgery and the role of perioperative antibiotics
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Published: | April 28, 2011 |
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Objective: This retrospective study aimed to determine the risk factors and bacteriological features of surgical site infections after neurosurgical procedures of the brain with special emphasis on perioperative antibiotic prophylaxis in preventing these infections
Methods: This study includes 918 patients who underwent a total of 1422 surgical procedures operated within a 26-month period. Pre-, intra- and postoperative variables such as patient age and risk factors, kind of craniotomy, emergency or elective surgery, duration of surgeries, and prolonged postoperative stay in the intensive care unit were correlated with the surgical infection rate.
Results: The overall infection rate was 6% for surgery-associated infections and 15.2% for general infections, e.g. pneumonia. Significant risk factors for surgery-associated infections were the duration of the surgical procedure, emergency surgery, postoperative length-of-stay in the intensive care unit for over 24 hours and the use of intracranial implants. 64% of the patients received antibiotic prophylaxis; a first-generation cephalosporin was most commonly administered. In patients receiving no antibiotics, the predominant bacteria were gram-negative, whereas patients receiving perioperative antibiotics most often suffered from infections by gram-positive bacteria. Although prophylactic antibiotic use significantly reduced the length of hospital stay (23 days vs. 28 days, p = 0.0003), it did not prevent postoperative infections.
Conclusions: Surgical site infections remain an important problem in neurosurgery. The identification of risk factors for surgical site infections is important for the quality assurance of any medical unit and will help improve patient care. The use of a single shot dose of perioperative antibiotics is a commonly employed method. Although it significantly reduced the length of hospital stay, it is not sufficient for preventing surgical site infections in neurosurgery.