Postoperative Central Nervous
System Infection: Incidence and Associated Factors In 2,111 Neurosurgery Cases
Shearwood McClelland III M.D., Walter A. Hall
M.D., M.B.A.
Department of Neurosurgery, University of Minnesota
Medical School, Minneapolis, MN
Introduction:
Postoperative
central nervous system infection (PCNSI) in the neurosurgical patient
represents a serious problem requiring immediate attention, most commonly
manifesting as meningitis, subdural empyema, and/or brain abscess. Recent studies with a minimum of 1,000
cases have reported the incidence of PCNSI following neurosurgery at 5-7%, with
many physicians believing the true incidence to be even higher. To address this issue, we examined the
incidence of PCNSI in a sizeable patient population.
Methods:
The
medical records and postoperative course of 2,111 neurosurgical cases treated
at our institution from 1991-2005 were reviewed retrospectively for the
incidence of PCNSI, identity of offending organisms, and factors associated
with infection.
Results:
Median
age at surgery was 45 years old.
Of the 1,587 cranial surgery cases, 14 (0.8%) were complicated by PCNSI,
while none of the 32 peripheral nerve surgery cases resulted in PCNSI. The remaining 492 cases involved spinal
surgery, of which 2 (0.4%) were complicated by PCNSI. The overall PCNSI incidence was 16/2111 (0.8%), with the
incidence of bacterial meningitis being 4/1587 (0.3%) and brain abscess being
3/1587 (0.2%). The most common
offending organism was Staphylococcus aureus (8 cases; 50% of infections),
followed by Propionibacterium acnes (4 cases; 25% of infections). Cerebrospinal fluid (CSF) leakage,
diabetes mellitus (DM), and male gender were not associated with PCNSI
(P>0.05).
Conclusion:
In
one of the largest neurosurgical series investigating PCNSI, the incidence of
infection following operative neurosurgery was less than 1%, more than six
times lower than reports involving comparable patient size. CSF leak, DM, and male gender were not
associated with an increased incidence of PCNSI. The results from this series indicate that the true
incidence of PCNSI following neurosurgery has been greatly overestimated in the
literature, and that in cases associated with high infection risk, prophylaxis
for Staphylococcus aureus and/or Propionibacterium acnes should be of primary
concern.
Keywords:
Postoperative Central
Nervous System Infection, Intracranial Neurosurgery, Spinal Neurosurgery,
Staphylococcus Aureus, Propionibacterium Acnes
Objectives:
1.
Understand the incidence
of postoperative central nervous system infection (PCNSI) in the neurosurgical
patient
2.
Be familiar with the
risk factors associated with PCNSI following neurosurgery
3.
Know the organisms most
likely to cause PCNSI in the neurosurgical patient
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