Incidence and risk factors of neurosurgical site infections: results of a prospective multicenter cohort study on 6359 surgeries

Passis Group

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: Neurosurgical surgical site infections (SSI) are life-threatening complications, requiring medical treatment and additional surgeries and remain a substantial cause of morbidity. In order to identify the incidence and the main risk factors for SSI, we developed the Prophylaxis with Antibiotic protocol for neuroSurgical Site Infections Study (PASSIS), a prospective observational multicenter cohort study for examining a large number of neurosurgical procedures.

METHODS: The study PASSIS involved four Italian Neurosurgical Departments applying the same antibiotic prophylaxis (ABP) protocol on 6359 consecutive neurosurgical procedures. In high-risk conditions (intra-operative contamination and/or post-operative cerebro-spinal fluid (CSF), and/or subcutaneous drainage and/or post-operative hyperpyrexia), and in presence of wound complication (CSF leak and/or CSF collection and/or wound diastasis), a prolongation protocol was prescribed.

RESULTS: The crude rate of SSI in the whole series was and 1.7% for patient and 1.5% for procedure. Patient related SSI risk factors: Younger patients (≤14 years) had a significantly higher SSI risk compared with older patients (RR: 2.17; CI 95%: 1.13- 4.14). Patients underwent two surgeries were at increased SSI risk (RR: 3.80; CI 95% 2.33-6.18), and the risk increased with the number of surgeries. Surgeries lasting longer than 3 hours (RR: 2.27; CI 95% 1.15-4.50), undergoing two or more surgeries and the presence of prosthetic implants (RR: 2.40; CI 95% 1.53- 3.77) were procedure related SSI risk factors positively associated with SSI. In high-risk conditions and in wound complication as defined previously, ABP prolongation showed limited efficacy (RR:1.97; CI 95% 1.21-3.22 and 9.31; CI 95% 5.90-14.68 respectively).

CONCLUSIONS: The subjects submitted to complicated, repeated, long lasting craniotomies, especially if experiencing postoperative deterioration, display the higher risk of SSIs, as a final life threatening complication. In order to reduce the SSI rate, further studies should address to design tailored prophylaxis protocols for each high risk situation as hereby defined; the wound complications deserve an increased microbiological surveillance, focusing the attention on the timing and source of infections.

Original languageEnglish
JournalJournal of Neurosurgical Sciences
DOIs
Publication statusE-pub ahead of print - Mar 26 2018

Fingerprint

Surgical Wound Infection
Multicenter Studies
Cohort Studies
Incidence
Antibiotic Prophylaxis
Infection
Neurosurgical Procedures
Cerebrospinal Fluid
Wounds and Injuries
Craniotomy
Drainage
Prospective Studies
Morbidity

Cite this

@article{6652238aa8d44a67839c0df0a5722432,
title = "Incidence and risk factors of neurosurgical site infections: results of a prospective multicenter cohort study on 6359 surgeries",
abstract = "OBJECTIVES: Neurosurgical surgical site infections (SSI) are life-threatening complications, requiring medical treatment and additional surgeries and remain a substantial cause of morbidity. In order to identify the incidence and the main risk factors for SSI, we developed the Prophylaxis with Antibiotic protocol for neuroSurgical Site Infections Study (PASSIS), a prospective observational multicenter cohort study for examining a large number of neurosurgical procedures.METHODS: The study PASSIS involved four Italian Neurosurgical Departments applying the same antibiotic prophylaxis (ABP) protocol on 6359 consecutive neurosurgical procedures. In high-risk conditions (intra-operative contamination and/or post-operative cerebro-spinal fluid (CSF), and/or subcutaneous drainage and/or post-operative hyperpyrexia), and in presence of wound complication (CSF leak and/or CSF collection and/or wound diastasis), a prolongation protocol was prescribed.RESULTS: The crude rate of SSI in the whole series was and 1.7{\%} for patient and 1.5{\%} for procedure. Patient related SSI risk factors: Younger patients (≤14 years) had a significantly higher SSI risk compared with older patients (RR: 2.17; CI 95{\%}: 1.13- 4.14). Patients underwent two surgeries were at increased SSI risk (RR: 3.80; CI 95{\%} 2.33-6.18), and the risk increased with the number of surgeries. Surgeries lasting longer than 3 hours (RR: 2.27; CI 95{\%} 1.15-4.50), undergoing two or more surgeries and the presence of prosthetic implants (RR: 2.40; CI 95{\%} 1.53- 3.77) were procedure related SSI risk factors positively associated with SSI. In high-risk conditions and in wound complication as defined previously, ABP prolongation showed limited efficacy (RR:1.97; CI 95{\%} 1.21-3.22 and 9.31; CI 95{\%} 5.90-14.68 respectively).CONCLUSIONS: The subjects submitted to complicated, repeated, long lasting craniotomies, especially if experiencing postoperative deterioration, display the higher risk of SSIs, as a final life threatening complication. In order to reduce the SSI rate, further studies should address to design tailored prophylaxis protocols for each high risk situation as hereby defined; the wound complications deserve an increased microbiological surveillance, focusing the attention on the timing and source of infections.",
author = "{Passis Group} and Laura Valentini and Francesca Chiaffarino and Nicoletta Bonfanti and Marilou Pannacci and Paolo Cortellazzi and Caterina Uberti-Foppa and Marika Furlanetto and {DI Meco}, Francesco and Luca Massimi",
year = "2018",
month = "3",
day = "26",
doi = "10.23736/S0390-5616.18.04322-9",
language = "English",
journal = "Journal of Neurosurgical Sciences",
issn = "0026-4881",
publisher = "Edizioni Minerva Medica S.p.A.",

}

TY - JOUR

T1 - Incidence and risk factors of neurosurgical site infections

T2 - results of a prospective multicenter cohort study on 6359 surgeries

AU - Passis Group

AU - Valentini, Laura

AU - Chiaffarino, Francesca

AU - Bonfanti, Nicoletta

AU - Pannacci, Marilou

AU - Cortellazzi, Paolo

AU - Uberti-Foppa, Caterina

AU - Furlanetto, Marika

AU - DI Meco, Francesco

AU - Massimi, Luca

PY - 2018/3/26

Y1 - 2018/3/26

N2 - OBJECTIVES: Neurosurgical surgical site infections (SSI) are life-threatening complications, requiring medical treatment and additional surgeries and remain a substantial cause of morbidity. In order to identify the incidence and the main risk factors for SSI, we developed the Prophylaxis with Antibiotic protocol for neuroSurgical Site Infections Study (PASSIS), a prospective observational multicenter cohort study for examining a large number of neurosurgical procedures.METHODS: The study PASSIS involved four Italian Neurosurgical Departments applying the same antibiotic prophylaxis (ABP) protocol on 6359 consecutive neurosurgical procedures. In high-risk conditions (intra-operative contamination and/or post-operative cerebro-spinal fluid (CSF), and/or subcutaneous drainage and/or post-operative hyperpyrexia), and in presence of wound complication (CSF leak and/or CSF collection and/or wound diastasis), a prolongation protocol was prescribed.RESULTS: The crude rate of SSI in the whole series was and 1.7% for patient and 1.5% for procedure. Patient related SSI risk factors: Younger patients (≤14 years) had a significantly higher SSI risk compared with older patients (RR: 2.17; CI 95%: 1.13- 4.14). Patients underwent two surgeries were at increased SSI risk (RR: 3.80; CI 95% 2.33-6.18), and the risk increased with the number of surgeries. Surgeries lasting longer than 3 hours (RR: 2.27; CI 95% 1.15-4.50), undergoing two or more surgeries and the presence of prosthetic implants (RR: 2.40; CI 95% 1.53- 3.77) were procedure related SSI risk factors positively associated with SSI. In high-risk conditions and in wound complication as defined previously, ABP prolongation showed limited efficacy (RR:1.97; CI 95% 1.21-3.22 and 9.31; CI 95% 5.90-14.68 respectively).CONCLUSIONS: The subjects submitted to complicated, repeated, long lasting craniotomies, especially if experiencing postoperative deterioration, display the higher risk of SSIs, as a final life threatening complication. In order to reduce the SSI rate, further studies should address to design tailored prophylaxis protocols for each high risk situation as hereby defined; the wound complications deserve an increased microbiological surveillance, focusing the attention on the timing and source of infections.

AB - OBJECTIVES: Neurosurgical surgical site infections (SSI) are life-threatening complications, requiring medical treatment and additional surgeries and remain a substantial cause of morbidity. In order to identify the incidence and the main risk factors for SSI, we developed the Prophylaxis with Antibiotic protocol for neuroSurgical Site Infections Study (PASSIS), a prospective observational multicenter cohort study for examining a large number of neurosurgical procedures.METHODS: The study PASSIS involved four Italian Neurosurgical Departments applying the same antibiotic prophylaxis (ABP) protocol on 6359 consecutive neurosurgical procedures. In high-risk conditions (intra-operative contamination and/or post-operative cerebro-spinal fluid (CSF), and/or subcutaneous drainage and/or post-operative hyperpyrexia), and in presence of wound complication (CSF leak and/or CSF collection and/or wound diastasis), a prolongation protocol was prescribed.RESULTS: The crude rate of SSI in the whole series was and 1.7% for patient and 1.5% for procedure. Patient related SSI risk factors: Younger patients (≤14 years) had a significantly higher SSI risk compared with older patients (RR: 2.17; CI 95%: 1.13- 4.14). Patients underwent two surgeries were at increased SSI risk (RR: 3.80; CI 95% 2.33-6.18), and the risk increased with the number of surgeries. Surgeries lasting longer than 3 hours (RR: 2.27; CI 95% 1.15-4.50), undergoing two or more surgeries and the presence of prosthetic implants (RR: 2.40; CI 95% 1.53- 3.77) were procedure related SSI risk factors positively associated with SSI. In high-risk conditions and in wound complication as defined previously, ABP prolongation showed limited efficacy (RR:1.97; CI 95% 1.21-3.22 and 9.31; CI 95% 5.90-14.68 respectively).CONCLUSIONS: The subjects submitted to complicated, repeated, long lasting craniotomies, especially if experiencing postoperative deterioration, display the higher risk of SSIs, as a final life threatening complication. In order to reduce the SSI rate, further studies should address to design tailored prophylaxis protocols for each high risk situation as hereby defined; the wound complications deserve an increased microbiological surveillance, focusing the attention on the timing and source of infections.

U2 - 10.23736/S0390-5616.18.04322-9

DO - 10.23736/S0390-5616.18.04322-9

M3 - Article

C2 - 29582969

JO - Journal of Neurosurgical Sciences

JF - Journal of Neurosurgical Sciences

SN - 0026-4881

ER -