DOI QR코드

DOI QR Code

Prospective Multicenter Surveillance Study of Surgical Site Infection after Intracranial Procedures in Korea : A Preliminary Study

  • Jeong, Tae Seok (Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine) ;
  • Yee, Gi Taek (Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine)
  • Received : 2018.01.28
  • Accepted : 2018.04.24
  • Published : 2018.09.01

Abstract

Objective : This study aimed to investigate the rates, types, and risk factors of surgical site infection (SSI) following intracranial neurosurgical procedures evaluated by a Korean SSI surveillance system. Methods : This was a prospective observational study of patients who underwent neurosurgical procedures at 29 hospitals in South Korea from January 2017 to June 2017. The procedures included craniectomy, craniotomy, cranioplasty, burr hole, and ventriculoperitoneal shunt. Univariate and multivariate logistic regression analyses were performed. Results : Of the 1576 cases included, 30 showed infection, for an overall SSI rate of 1.9%. Organ/space infection was the most common, found in 21 out of the 30 cases (70%). Staphylococcus aureus was the most common (41%) of all bacteria, and Serratia marcescens (12%) was the most common among gram-negative bacteria. In univariate analyses, the p-values for age, preoperative hospital stay duration, and over T-hour were <0.2. In a multivariate analysis of these variables, only preoperative hospital stay was significantly associated with the incidence of SSI (p<0.001), whereas age and over T-hour showed a tendency to increase the risk of SSI (p=0.09 and 0.06). Conclusion : Surveillance systems play important roles in the accurate analysis of SSI. The incidence of SSI after neurosurgical procedures assessed by a national surveillance system was 1.9%. Future studies will provide clinically useful results for SSI when data are accumulated.

Keywords

References

  1. American Society of Anesthesiologists (ASA) : ASA physical status classification system. Available at : https://www.asahq.org/resources/clinical-information/asa-physical-status-classification-system
  2. Blomstedt GC : Infections in neurosurgery: a retrospective study of 1143 patients and 1517 operations. Acta Neurochir (Wien) 78 : 81-90, 1985 https://doi.org/10.1007/BF01808684
  3. Buang SS, Haspani MS : Risk factors for neurosurgical site infections after a neurosurgical procedure: a prospective observational study at Hospital Kuala Lumpur. Med J Malaysia 67 : 393-398, 2012
  4. Centers for Disease Control and Prevention (CDC) : Surgical site infection (SSI) event. Available at : http://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf
  5. Centers for Disease Control and Prevention (CDC) : CDC/NHSN Surveillance Definitions for Specific Types of Infections. Available at : https://www.cdc.gov/nhsn/pdfs/pscmanual/17pscnosinfdef_current.pdf
  6. Centers for Disease Control and Prevention : Public health then and now: celebrating 50 years of MMWR at CDC. Available at : https://www.cdc.gov/mmwr/pdf/other/su6004.pdf
  7. Chiang HY, Kamath AS, Pottinger JM, Greenlee JD, Howard III MA, Cavanaugh JE, et al. : Risk factors and outcomes associated with surgical site infections after craniotomy or craniectomy. J Neurosurg 120 : 509-521, 2014 https://doi.org/10.3171/2013.9.JNS13843
  8. Dixon RE, Centers for Disease Control and Prevention (CDC) : Control of health-care-associated infections, 1961-2011. MMWR Suppl 60 : 58-63, 2011
  9. Emori TG, Gaynes RP : An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev 6 : 428-442, 1993 https://doi.org/10.1128/CMR.6.4.428
  10. Gastmeier P, Kampf G, Wischnewski N, Hauer T, Schulgen G, Schumacher M, et al. : Prevalence of nosocomial infections in representative German hospitals. J Hosp Infect 38 : 37-49, 1998 https://doi.org/10.1016/S0195-6701(98)90173-6
  11. Gaynes RP, Culver DH, Horan TC, Edwards JR, Richards C, Tolson JS, et al. : Surgical site infection (SSI) rates in the United States, 1992-1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clin Infect Dis 33 (Suppl 2) : S69-S77, 2001 https://doi.org/10.1086/321860
  12. Hadid H, Usman M, Thapa S : Severe osteomyelitis and septic arthritis due to serratia marcescens in an Immunocompetent Patient. Case Rep Infect Dis 2015 : 347652, 2015
  13. Haley RW, Culver DH, White JW, Morgan WM, Emori TG, Munn VP, et al. : The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 121 : 182-205, 1985 https://doi.org/10.1093/oxfordjournals.aje.a113990
  14. Hall WA, Truwit CL : The surgical management of infections involving the cerebrum. Neurosurgery 62 (Suppl 2) : SHC519-SHC530; discussion 530-531, 2008 https://doi.org/10.1227/01.neu.0000316255.36726.5b
  15. Korinek AM : Risk factors for neurosurgical site infections after craniotomy: a prospective multicenter study of 2944 patients. The French Study Group of Neurosurgical Infections, the SEHP, and the C-CLIN Paris-Nord. Service Epidemiologie Hygiene et Prevention. Neurosurgery 41 : 1073-1079; discussion 1079-1081, 1997 https://doi.org/10.1097/00006123-199711000-00010
  16. Korinek A, Golmard J, Elcheick A, Bismuth R, Van Effenterre R, Coriat P, et al. : Risk factors for neurosurgical site infections after craniotomy: a critical reappraisal of antibiotic prophylaxis on 4578 patients. Br J Neurosurg 19 : 155-162, 2005 https://doi.org/10.1080/02688690500145639
  17. Kourbeti IS, Jacobs AV, Koslow M, Karabetsos D, Holzman RS : Risk factors associated with postcraniotomy meningitis. Neurosurgery 60 : 317-325; discussion 325-326, 2007 https://doi.org/10.1227/01.NEU.0000249266.26322.25
  18. Lew DP, Waldvogel FA : Osteomyelitis. The Lancet 364 : 369-379, 2004 https://doi.org/10.1016/S0140-6736(04)16727-5
  19. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, The Hospital Infection Control Practices Advisory Committee : Guideline for prevention of surgical site infection, 1999. Am J Infect Control 27 : 97-132; quiz 133-134; discussion 96, 1999 https://doi.org/10.1016/S0196-6553(99)70088-X
  20. McClelland III S, Hall WA : Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures. Clin Infect Dis 45 : 55-59, 2007 https://doi.org/10.1086/518580
  21. McLaws ML, Gold J, King K, Irwig LM, Berry G : The prevalence of nosocomial and community-acquired infections in Australian hospitals. Med J Aust 149 : 582-590, 1988
  22. Narotam PK, van Dellen JR, du Trevou MD, Gouws E : Operative sepsis in neurosurgery: a method of classifying surgical cases. Neurosurgery 34 : 409-415; discussion 415-416, 1994 https://doi.org/10.1227/00006123-199403000-00004
  23. Patir R, Mahapatra AK, Banerji AK : Risk factors in postoperative neurosurgical infection. A prospective study. Acta Neurochir (Wien) 119 : 80-84, 1992 https://doi.org/10.1007/BF01541786
  24. Plowman R : The socioeconomic burden of hospital acquired infection. Euro Surveill 5 : 49-50, 2000 https://doi.org/10.2807/esm.05.04.00004-en
  25. Schweizer M, Perencevich E, McDanel J, Carson J, Formanek M, Hafner J, et al. : Effectiveness of a bundled intervention of decolonization and prophylaxis to decrease Gram positive surgical site infections after cardiac or orthopedic surgery: systematic review and meta-analysis. BMJ 346 : f2743, 2013 https://doi.org/10.1136/bmj.f2743
  26. Tong SY, Davis JS, Eichenberger E, Holland TL, Fowler VG Jr : Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev 28 : 603-661, 2015 https://doi.org/10.1128/CMR.00134-14
  27. von Eiff C, Becker K, Machka K, Stammer H, Peters G : Nasal carriage as a source of Staphylococcus aureus bacteremia. N Engl J Med 344 : 11- 16, 2001 https://doi.org/10.1056/NEJM200101043440102
  28. Wilhelmi I, de Quiros JB, Romero-Vivas J, Duarte J, Rojo E, Bouza E : Epidemic outbreak of Serratia marcescens infection in a cardiac surgery unit. J Clin Microbiol 25 : 1298-1300, 1987
  29. Yu VL : Serratia marcescens: historical perspective and clinical review. N Engl J Med 300 : 887-893, 1979 https://doi.org/10.1056/NEJM197904193001604

Cited by

  1. Cranioplasty Results after the Use of a Polyester Urethane Dural Substitute (Neuro-Patch®) as an Adhesion Prevention Material in Traumatic Decompressive Craniectomy vol.32, pp.4, 2019, https://doi.org/10.20408/jti.2019.030
  2. Efficacy and safety of decompressive craniectomy with non-suture duraplasty in patients with traumatic brain injury vol.15, pp.10, 2020, https://doi.org/10.1371/journal.pone.0232561
  3. HEALTHCARE-ASSOCIATED INFECTION IN NEUROSURGICAL PATIENTS IN UKRAINE: RESULTS OF A MULTICENTER STUDY (2017-2019) vol.74, pp.8, 2021, https://doi.org/10.36740/wlek202108129
  4. A Care Bundle Intervention to Prevent Surgical Site Infections After a Craniotomy vol.73, pp.11, 2021, https://doi.org/10.1093/cid/ciaa884