Surgical site infection (SSI)

see also Surgical site infection in spine surgery

see also Surgical site infection in cranioplasty.

A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place.

Surgical site infections pose a significant problem in the treatment of neurosurgical procedures, regardless of the application of perioperative prophylaxis with systemic antibiotics. The infection rate in these procedures ranges from less than 1% to above 15%.

Neurosurgical wound infections are the most common and serious complications resulting in increased rates of morbidity and mortality ¹⁾.

Active outpatient follow-up is not necessary and monitoring of inpatients and readmissions is enough for a cranial neurosurgical SSI programme ²⁾.

Several studies had been reported lower incidence of neurosurgical wound infection ^{3) 4)}.

The neurosurgical wound infection rate is usually low even in developing countries and remains within the accepted rate ⁵⁾.

Predictors of SSI and hospital readmission differ in the US, Denmark and Japan, suggesting that risk stratification models may need to be population specific or adjusted. Some differences in measured parameters exist in the 3 databases analyzed, however, patient and procedure selection also appear to differ and may limit the ability to directly pool data from different regions. Therefore, risk stratification models developed in one country may not be directly applicable to other countries ⁶⁾.

SSIs are classified into incisional SSIs, which can be superficial or deep, and organ/space SSIs, which affect the rest of the body other than the body wall layers.

These classifications are defined as follows:

Superficial incisional SSI - Infection involves only skin and subcutaneous tissue of incision

Deep incisional SSI - Infection involves deep tissues, such as fascial and muscle layers; this also includes infection involving both superficial and deep incision sites and organ/space SSI draining through incision.

see Deep wound infection

Organ/space SSI - Infection involves any part of the anatomy in organs and spaces other than the incision, which was opened or manipulated during operation.

Pediatric surgical site infection

Surgical site infections (SSIs) are potential complications occurring after surgery. Despite the availability of prophylactic antibiotics and aseptic technique, they remain a cause for concern ^{7) 8)}.

The most common microorganisms isolated from SSI were Staphylococcus aureus (23%), Enterobacteriaceae (21%), and Propionibacterium acnes (12%) ⁹⁾.

see Surgical site infection risk factors.

A wound infection can manifest itself by local symptoms, for example, by suppuration, or by general symptoms, for example, by fever, weakness, or posttraumatic sepsis.

Diagnosis of surgical site infection appears to rely primarily on clinical factors and laboratory values, such as C-Reactive Protein, are not universally sensitive. Similarly, novel methods of perioperative infection prophylaxis such as local antibiotic administration appear to be modestly effective.

SSI and bone flap resorption are the most frequent complications associated with the reimplantation of autologous cryopreserved bone after decompressive craniectomy. Prolonged procedural time and cardiovascular comorbidity tend to increase the risk of SSI ¹⁰⁾.

Sepsis and tetanus are severe forms of general wound infection. Causative agents include staphylococci, Pseudomonas aeruginosa, and colon bacillus. Associations of these microorganisms are frequently observed. The causative agents of anaerobic infection are less commonly observed. Microorganisms always penetrate a wound, although infection rarely develops if the body and injured tissues are adequately resistant and primary surgical treatment is prompt.

Surgical site infection prevention.

Surgical site infection case series.