In this study, we aimed to identify the aetiology and risk factors of SSI-CRAN in a large contemporary cohort of consecutive adult patients undergoing craniotomy in a university hospital.Ī prospective cohort study was carried out in a 700-bed university hospital for adults in Barcelona, Spain, which admits average of 1300 patients to the neurosurgery ward each year. An accurate identification of the risk factors and main causative pathogens of SSI-CRAN might be helpful in the design of future preventive strategies. Therefore, more evidence is still needed to define more precisely the risk factors for developing SSI-CRAN. However, those studies presented certain limitations, such as small sample sizes, substantial variations in the inclusion criteria, and marked differences in patients’ baseline characteristics. Previous studies have identified several associated factors, including age, gender, duration of operation, surgical site, reason for surgery, emergency procedure, antibiotic prophylaxis, steroid use, cerebrospinal fluid (CSF) drainage, and American Society of Anesthesiologists (ASA) score. The risk factors for SSI-CRAN are still poorly understood. Indeed, SSI-CRAN is associated with longer hospital stay, significant health care costs, and non-negligible mortality. SSI-CRAN has potentially devastating consequences: it is associated with significant morbidity and requires complex treatment that often involves the removal of the bone flap and long-term antibiotic therapy. The incidence of surgical site infection after craniotomy (SSI-CRAN) ranges from 2.2 to 19.8%. In many cases, metal plates are used to hold the bone flap in place. The bone flap is temporarily separated and is returned to its previous location at the end of surgery in order to protect the brain and its structures. 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.Ĭraniotomy is a surgical procedure in which part of the skull bone is removed to expose the brain and the central nervous system. 35.5% in SSI-CRAN and no SSI-CRAN respectively, p = 0.025), extrinsic tumour (28.6% vs.
In the univariate analysis the factors associated with SSI-CRAN were ASA score > 2 (48.4% vs. 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. Baseline demographic characteristics were similar among patients who developed SSI-CRAN and those who did not. ResultsĪmong the 595 patients who underwent craniotomy, 91 (15.3%) episodes of SSI-CRAN were recorded, 67 (73.6%) of which were organ/space. Multivariate analysis was carried out to identify independent risk factors for SSI-CRAN. Patients were followed up in an active post-discharge surveillance programm e for up to one year after surgery. Demographic, epidemiological, surgical, clinical and microbiological data were collected.
MethodsĪ series of consecutive patients who underwent craniotomy at a university hospital from January 2013 to December 2015 were prospectively assessed.
We aim to identify the risk factors for developing SSI-CRAN in a large prospective cohort of adult patients undergoing craniotomy. Although surgical site infection after craniotomy (SSI-CRAN) is a serious complication, risk factors for its development have not been well defined.