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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