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).

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).

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.

Lietard C, Thébaud V, Besson G, Lejeune B: Risk factors for neurosurgical site infections: An 18 month prospective study. J Neurosurg 109:729-734, 2008
Davies BM, Jones A, Patel HC. Surgical-site infection surveillance in cranial neurosurgery. Br J Neurosurg. 2015 Aug 27:1-3. [Epub ahead of print] PubMed PMID: 26313320.
McClelland S, Hall WA: Postoperative central nervous system infection: Incidence and associated factors in 2111 neurosur- gical procedures. Clinical Infectious Diseases 45:55-59,2007
Valentini LG, Casali C, Chatenoud L, Chiaffarino F: Surgical site infections after elective neurosurgery: A survey of 1747 patients. Neurosurgery 61:88-96, 2007
Taha MM, Abouhashem S, Abdel-Rahman AY. Neurosurgical wound infection at a university hospital in egypt; prospective study of 1181 patients for 2 years.Turk Neurosurg. 2014;24(1):8-12. doi: 10.5137/1019-5149.JTN.6464-12.1. PubMed PMID: 24535784.
Glassman S, Carreon LY, Andersen M, Asher A, Eiskjær S, Gehrchen M, Imagama S, Ishii K, Kaito T, Matsuyama Y, Moridaira H, Mummaneni P, Shaffrey C, Matsumoto M. Predictors of Hospital Re-admission and Surgical Site Infection in the United States, Denmark and Japan: Is Risk Stratification a Universal Language? Spine (Phila Pa 1976). 2017 Jan 31. doi: 10.1097/BRS.0000000000002082. [Epub ahead of print] PubMed PMID: 28146028.
North American Spine Society Evidence-Based Clinical Guidelines Committee. Antibiotic Prophylaxis in Spine Surgery. Burr Ridge, IL: North American Spine Society (NASS); 2013
Chahoud J, Kanafani Z, Kanj SS. Surgical site infections following spine surgery: Eliminating the controversies in the diagnosis. Front Med (Lausanne) 2014;1:7.
Cassir N, De La Rosa S, Melot A, Touta A, Troude L, Loundou A, Richet H, Roche PH. Risk factors for surgical site infections after neurosurgery: A focus on the postoperative period. Am J Infect Control. 2015 Aug 20. pii: S0196-6553(15)00756-7. doi: 10.1016/j.ajic.2015.07.005. [Epub ahead of print] PubMed PMID: 26300100.
Sundseth J, Sundseth A, Berg-Johnsen J, Sorteberg W, Lindegaard KF. Cranioplasty with autologous cryopreserved bone after decompressive craniectomy. Complications and risk factors for developing surgical site infection. Acta Neurochir (Wien). 2014 Feb 4. [Epub ahead of print] PubMed PMID: 24493001
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