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Magni F, Al-Omari A, Vardanyan R, Rad AA, Honeyman S, Boukas A. An update on a persisting challenge: A systematic review and meta-analysis of the risk factors for surgical site infection post craniotomy. Am J Infect Control 2024; 52:650-658. [PMID: 37989412 DOI: 10.1016/j.ajic.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Surgical site infections (SSIs) postcraniotomy continue to impose a significant burden on health care systems and patient outcomes. It is, therefore, important to understand their risk factors in order to promote effective preventative measures. This meta-analysis aims to provide a comprehensive, up-to-date analysis of the risk factors associated with SSIs in neurosurgical procedures. METHODS A systematic review was conducted as per preferred reporting items for systematic reviews and meta-analysis guidelines to explore existing primary evidence on the risk factors for SSIs postcraniotomy. A comprehensive search of MEDLINE, EMBASE, and Pubmed was performed from database inception up to June 2023. 43 studies were included in the meta-analysis, encompassing a total of 68,881 patients. RESULTS The strongest predictor for SSIs was found to be cerebrospinal fluid (CSF) leak (OR: 8.91, CI: 4.30-18.44). Other significant factors included infratentorial surgery (OR: 0.43, CI: 0.31-0.61), emergency surgery (OR: 1.41, CI: 1.05-1.91), reintervention (OR: 3.19, CI: 1.77-5.75), prolonged operative time (mean difference: 33.25; CI: 18.83-47.67), hospital length of stay (mean difference: 0.60; CI: 0.23-0.98) and intracranial pressure monitor (ICPM) insertion (OR: 1.81; CI: 1.06-3.11). Contrarily, sex, body mass index (BMI), diabetes, antibiotic prophylaxis, immunosuppressive agents, trauma, use of artificial implants did not demonstrate statistical significance. CONCLUSIONS This meta-analysis provides an up-to-date and comprehensive evaluation of risk factors for SSIs postcraniotomy. It emphasizes the need for preventive strategies, particularly against CSF leaks, and calls for further research to elucidate the intricate relationships between these factors.
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Affiliation(s)
- Francesco Magni
- Department of Neurosurgery, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.
| | - Aws Al-Omari
- Department of Neurosurgery, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Robert Vardanyan
- Department of Neurosurgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Arian A Rad
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Susan Honeyman
- Department of Neurosurgery, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Alexandros Boukas
- Department of Neurosurgery, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
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Sun D, Ma Z, Geng Y, Kong C, Li Z. A meta-analysis of the risk factors for neurosurgical surgical site infection following craniotomy. Int Wound J 2024; 21:e14542. [PMID: 38140754 PMCID: PMC10961046 DOI: 10.1111/iwj.14542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
The purpose of the meta-analysis was to evaluate and compare the risk factors for neurosurgical surgical site infection (SSI) after craniotomy. Using dichotomous or contentious random or fixed effect models, the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were computed based on the examination of the meta-analysis results. Eighteen analyses, covering 11 068 craniotomies between 2001 and 2023, were included in the current meta-analysis. Subjects with SSIs had a significantly younger age (MD, -2.49; 95% CI, -2.95 to -2.04, p < 0.001), longer operation duration (MD, 10.21; 95% CI, 6.49-13.94, p < 0.001) and longer length of postoperative hospital stay (MD, 1.52; 95% CI, 0.45-2.60, p = 0.006) compared to subjects with no SSI with craniotomy. However, no significant difference was found between craniotomy subjects with SSIs and with no SSI in gender (OR, 0.90; 95% CI, 0.76-1.07, p = 0.23), and combination with other infection (OR, 3.93; 95% CI, 0.28-56.01, p = 0.31). The data that were looked at showed that younger age, longer operation duration and longer length of postoperative hospital stay can be considered as risk factors of SSI in subjects with craniotomy; however, gender and combination with other infections are not. Nonetheless, consideration should be given to their values because several studies only involved a small number of patients, and there are not many studies available for some comparisons.
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Affiliation(s)
- Dechao Sun
- Department of NeurosurgeryHuaihe Hospital of Henan UniversityKaifengChina
| | - Zhuang Ma
- Department of NeurosurgeryHuaihe Hospital of Henan UniversityKaifengChina
| | - Yadong Geng
- Department of NeurosurgeryHuaihe Hospital of Henan UniversityKaifengChina
| | - Chenxu Kong
- Department of NeurosurgeryHuaihe Hospital of Henan UniversityKaifengChina
| | - Zhenjiang Li
- Department of NeurosurgeryHuaihe Hospital of Henan UniversityKaifengChina
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Gu Z, Tu C, Song D, Yang Z, Xia J. Comprehensive analysis of risk factors and pathogenetic characteristics associated with surgical site infections following craniotomy procedures. Int Wound J 2024; 21:e14550. [PMID: 38069518 PMCID: PMC10961042 DOI: 10.1111/iwj.14550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/19/2023] [Accepted: 11/23/2023] [Indexed: 03/25/2024] Open
Abstract
Craniotomies are intricate neurosurgical procedures susceptible to post-operative complications, among which surgical site infections (SSIs) are particularly concerning. This study sought to elucidate the potential risk factors and pathogenetic characteristics associated with SSIs following craniotomy procedures in a clinical setting. A retrospective study was conducted from May 2020 to May 2023, examining patients subjected to elective or emergency craniotomies. The cohort underwent post-operative surveillance for SSIs, facilitating patient classification into SSI and Non-SSI groups based on infection occurrence. Data collection encapsulated demographic and clinical parameters, including American Society of Anesthesiologists (ASA) classifications, and operative factors. SSIs were diagnosed via an integrated approach combining clinical symptoms, microbiological culture findings and pertinent laboratory tests. A rigorous statistical methodology employing IBM's SPSS version 27.0 was utilised for data analysis. In a univariate analysis, significant risk factors for post-craniotomy SSIs were identified, with patients aged over 60 displaying a pronounced susceptibility. Moreover, surgeries exceeding a duration of 4 h heightened infection risks. Elevated ASA grades denoted an increased prevalence of SSIs, as did emergency procedures and higher National Nosocomial Infections Surveillance scores. Multivariate analysis pinpointed epidural/subdural drainage as a protective measure against SSIs, whereas emergency surgeries, operative times beyond 4 h and subsequent surgeries within the hospital stay amplified infection risks. Notably, coagulase-negative Staphylococcus dominated the identified pathogens at 28.09%, followed by Escherichia coli (17.98%), Klebsiella pneumoniae (10.11%) and Staphylococcus aureus (11.24%), underscoring the need for diverse prophylactic measures. SSIs following craniotomies present a multifaceted challenge influenced by a confluence of patient-related, operative and post-operative determinants. Understanding these risk factors is paramount in refining surgical protocols and post-operative care strategies to mitigate SSI incidence.
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Affiliation(s)
- Zhiwei Gu
- Department of NeurosurgeryThe Central Hospital Affiliated to Shaoxing UniversityShaoxingZhejiang ProvinceChina
| | - Chuanjian Tu
- Department of NeurosurgeryThe Central Hospital Affiliated to Shaoxing UniversityShaoxingZhejiang ProvinceChina
| | - Dagang Song
- Department of NeurosurgeryThe Central Hospital Affiliated to Shaoxing UniversityShaoxingZhejiang ProvinceChina
| | - Zhihao Yang
- Department of NeurosurgeryThe Central Hospital Affiliated to Shaoxing UniversityShaoxingZhejiang ProvinceChina
| | - Jiajie Xia
- Department of NeurosurgeryThe Central Hospital Affiliated to Shaoxing UniversityShaoxingZhejiang ProvinceChina
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Onsombi D, Mayaya G, Herrera V, Manyanga A, Leonald W, Byabato S, Lubuulwa J. The usefulness of surgical drains on short term outcomes among patients undergoing craniotomy at the Bugando Medical Centre, Mwanza Tanzania. World Neurosurg X 2024; 22:100323. [PMID: 38444869 PMCID: PMC10914571 DOI: 10.1016/j.wnsx.2024.100323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Affiliation(s)
- Dennis Onsombi
- Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
| | - Gerald Mayaya
- Department of Neurosurgery, Bugando Medical Center, Mwanza, Tanzania
| | - Vladimir Herrera
- Department of Neurosurgery, Bugando Medical Center, Mwanza, Tanzania
| | - Anton Manyanga
- Department of Neurosurgery, Bugando Medical Center, Mwanza, Tanzania
| | | | - Samuel Byabato
- Department of General Surgery, Bugando Medical Center, Mwanza, Tanzania
| | - James Lubuulwa
- Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
- Department of Neurosurgery, Bugando Medical Center, Mwanza, Tanzania
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Nadzri AN, Nik Mohamed NA, Payne SJ, Mohamed Mokhtarudin MJ. Poroelastic modelling of brain tissue swelling and decompressive craniectomy treatment in ischaemic stroke. Comput Methods Biomech Biomed Engin 2024:1-11. [PMID: 38461460 DOI: 10.1080/10255842.2024.2326972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/01/2024] [Indexed: 03/12/2024]
Abstract
Brain oedema or tissue swelling that develops after ischaemic stroke can cause detrimental effects, including brain herniation and increased intracranial pressure (ICP). These effects can be reduced by performing a decompressive craniectomy (DC) operation, in which a portion of the skull is removed to allow swollen brain tissue to expand outside the skull. In this study, a poroelastic model is used to investigate the effect of brain ischaemic infarct size and location on the severity of brain tissue swelling. Furthermore, the model will also be used to evaluate the effectiveness of DC surgery as a treatment for brain tissue swelling after ischaemia. The poroelastic model consists of two equations: one describing the elasticity of the brain tissue and the other describing the changes in the interstitial tissue pressure. The model is applied on an idealized brain geometry, and it is found that infarcts with radius larger than approximately 14 mm and located near the lateral ventricle produce worse brain midline shift, measured through lateral ventricle compression. Furthermore, the model is also able to show the positive effect of DC treatment in reducing the brain midline shift by allowing part of the brain tissue to expand through the skull opening. However, the model does not show a decrease in the interstitial pressure during DC treatment. Further improvement and validation could enhance the capability of the proposed poroelastic model in predicting the occurrence of brain tissue swelling and DC treatment post ischaemia.
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Affiliation(s)
- Aina Najwa Nadzri
- Faculty of Manufacturing and Mechatronics Engineering Technology, Universiti Malaysia Pahang, Pekan, Pahang, Malaysia
| | - Nik Abdullah Nik Mohamed
- Faculty of Engineering, Technology and Built Environment, UCSI University Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Stephen J Payne
- Institute of Applied Mechanics, National Taiwan University, Taipei, Taiwan
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Feng W, Sun C, Hao S, Yang J, Wang P, Wang Z, Liu X, Lou J, Yang Y. Risk assessment and pathogen profile of surgical site infections in traumatic brain injury patients undergoing emergency craniotomy: A retrospective study. Int Wound J 2024; 21:e14743. [PMID: 38420721 PMCID: PMC10902686 DOI: 10.1111/iwj.14743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/16/2024] [Accepted: 01/21/2024] [Indexed: 03/02/2024] Open
Abstract
Emergency craniotomy in patients with traumatic brain injury poses a significant risk for surgical site infections (SSIs). Understanding the risk factors and pathogenic characteristics of SSIs in this context is crucial for improving outcomes. This comprehensive retrospective analysis spanned from February 2020 to February 2023 at our institution. We included 25 patients with SSIs post-emergency craniotomy and a control group of 50 patients without SSIs. Data on various potential risk factors were collected, including demographic information, preoperative conditions, and intraoperative details. The BACT/ALERT3D Automated Bacterial Culture and Detection System was utilized for rapid bacterial pathogen identification. Statistical analyses included univariate and multivariate logistic regression to identify significant risk factors for SSIs. The study identified Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus as the most prevalent pathogens in SSIs. Significant risk factors for SSIs included the lack of preoperative antibiotic use, postoperative drainage tube placement, diabetes mellitus, and the incorporation of invasive procedures, all of which showed a significant association with SSIs in the univariate analysis. The multivariate analysis further highlighted the protective effect of preoperative antibiotics and the increased risks associated with anaemia, diabetes mellitus, postoperative drainage tube placement, and the incorporation of invasive procedures. Our research underscores the critical role of factors like insufficient preoperative antibiotics, postoperative drainage, invasive techniques, anaemia, and diabetes mellitus in elevating the risk of surgical site infections in traumatic brain injury patients undergoing emergency craniotomy. Enhanced focus on these areas is essential for improving surgical outcomes.
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Affiliation(s)
- Wenxian Feng
- Department of NeurosurgeryZhumadian Central HospitalZhumadianHenan ProvinceChina
| | - Changqing Sun
- Department of NeurosurgeryTianjin Baodi HospitalTianjinChina
| | - Sha Hao
- Department of OncologyJingmen Hospital of Traditional Chinese MedicineJingmenHubei ProvinceChina
| | - Jie Yang
- Department of PediatricsPeople's Hospital of PingyuZhumadianHenan ProvinceChina
| | - Pengfei Wang
- Department of NeurosurgeryPeople's Hospital of PingyuZhumadianHenan ProvinceChina
| | - Zong Wang
- Department of NeurosurgeryZhumadian Central HospitalZhumadianHenan ProvinceChina
| | - Xiatong Liu
- Department of NeurosurgeryZhumadian Central HospitalZhumadianHenan ProvinceChina
| | - Jinfeng Lou
- Department of NeurosurgerySecond Affiliated Hospital of Zhengzhou UniversityZhengzhouHenan ProvinceChina
| | - Yang Yang
- Department of NeurosurgeryZhumadian Central HospitalZhumadianHenan ProvinceChina
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Morgan E, Onuminya JE, Osime CO, Adebayo BO, Ehioghae O, Adetunmbi B. Efficacy of prophylactic use of intraoperative vancomycin powder in preventing surgical site infection in neurological surgeries in Irrua, Nigeria: A randomized controlled study. J Clin Neurosci 2024; 121:155-160. [PMID: 38401293 DOI: 10.1016/j.jocn.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/02/2024] [Accepted: 02/09/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE The objective was to determine the efficacy of intraoperative vancomycin powder in preventing SSIs in neurological surgeries. METHODS A prospective randomized controlled study of patients who had clean cranial and non-implant spine surgeries at the Irrua Specialist Teaching Hospital, Irrua, Nigeria from February 1, 2021 to January 31, 2022. Patients were randomized into two groups. Group A patients had prophylactic intraoperative vancomycin powder applied to the surgical bed before wound closure while group B patients did not. Patients in both groups were followed up for 30 days post-operatively for evidence of SSI. The occurrence of SSIs was determined using clinical and laboratory parameters. Baseline characteristics, operative details, rates of wound infection, and microbiological data for each case were recorded. Data was analyzed using Statistical Package for Scientific Solution (SPSS) version 23 software. RESULTS Forty-two patients were randomized into 2 groups of 21 patients each. The age range of the patients was 20 to 80 years. The majority of the patients were males (32 out of 42). The mean age of patients in group A was 48.05 ± 17.03 years, while group B had a mean age of 45.95 ± 19.14 years. The mean Body Mass Index of patients in groups A and B were 23.92 ± 5.21 and 23.21 ± 3.99 respectively. Seven out of 21 patients (33.3 %) in the control group ( group B) had superficial SSIs while no patient in the experimental group had SSI, p-value < 0.05. The organisms cultured were Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus. CONCLUSION Intraoperative vancomycin powder was effective in reducing the rate of SSIs following neurological surgeries and without adverse drug reactions.
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Affiliation(s)
- E Morgan
- Department of Surgery, Irrua Specialist Teaching Hospital Irrua, Nigeria; Department of Surgery, Babcock University, Ilishan-Remo, Ogun state, Nigeria.
| | - J E Onuminya
- Department of Orthopedic Surgery, Ambrose Alli University Ekpoma, Nigeria
| | - C O Osime
- Department of Surgery, University of Benin Teaching Hospital Benin, Nigeria
| | - B O Adebayo
- Neurosurgery Unit, Department of Surgery, Federal Medical Center, Abeokuta, Nigeria
| | - O Ehioghae
- Department of Surgery, Babcock University, Ilishan-Remo, Ogun state, Nigeria
| | - B Adetunmbi
- Neurosurgery Unit, Department of Surgery, Federal Medical Center, Abeokuta, Nigeria
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8
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Gu Z, Wang Q, Chen J, Zhu Y. Predicted factors of surgical site infection in glioblastoma patients: A meta-analysis. Int Wound J 2023; 21:e14504. [PMID: 38044279 PMCID: PMC10898386 DOI: 10.1111/iwj.14504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 12/05/2023] Open
Abstract
Surgical site infection (SSI) is one of the common postoperative complications after craniotomy for glioblastoma patients. Previous studies have investigated the risk factors for SSI in patients with glioblastoma. Whereas big differences in research results exist, and the correlation coefficients of different research results are quite different. A meta-analysis was conducted to examine the risk factors related to surgical site infection in patients with glioblastoma. We searched English databases to collect case-control studies or cohort studies published before 15 October 2023 including PubMed, Web of Science, Embase. The risk of bias of the included studies was assessed via Newcastle-Ottawa Scale. The analysis was performed using RevMan 5.4.1 tool. A total of 4 articles (n = 2222) were selected in this meta-analysis. The following risk factors were presented to be correlated with SSI in glioblastoma: irradiation (OR = 1.88, 95% CI [0.46, 7.60]), more than 3 surgeries (OR = 2.99, 95% CI [1.47, 6.08]). Occurrence of SSI is influenced by a variety of factors. Thus, we should pay close attention to high-risk subjects and take crucial targeted interventions to lower the SSI risk following craniotomy. Owing to the limited quality and quantity of the included studies, more rigorous studies with adequate sample sizes are needed to verify the conclusion.
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Affiliation(s)
- Zhaowen Gu
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Qiangwei Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jiarui Chen
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yongjian Zhu
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, China
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Dechaene V, Gallet C, Soueges S, Liu L, Delabar V, Adélaïde L, Jarraud S, Dauwalder O, Jouanneau E, Wan M, Jacquesson T, Guyotat J, Conrad A, Triffault-Fillit C, Ferry T, Valour F. Diagnostic, clinical management, and outcome of bone flap-related osteomyelitis after cranioplasty. Int J Infect Dis 2023; 137:48-54. [PMID: 37839505 DOI: 10.1016/j.ijid.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVES We aimed to describe diagnostic, management, and outcome of bone flap-related osteomyelitis after cranioplasty. METHODS Patients followed up in our tertiary care hospital for bone flap-related osteomyelitis after cranioplasty were included in a retrospective cohort (2008-2021). Determinants of treatment failure were assessed using logistic regression and Kaplan-Meier curves analysis. RESULTS The 144 included patients (81 [56.3%] males; median age 53.4 [interquartile range [IQR], 42.6-62.5] years) mostly presented wound abnormalities (n = 115, 79.9%). All infections were documented, the main pathogens being Staphylococcus aureus (n = 64, 44.4%), Cutibacterium acnes (n = 57, 39.6%), gram-negative bacilli (n = 40, 27.8%) and/or non-aureus staphylococci (n = 34, 23.6%). Surgery was performed in 140 (97.2%) cases, for bone flap removal (n = 102, 72.9%) or debridement with flap retention (n = 31, 22.1%), along with 12.7 (IQR, 8.0-14.0) weeks of antimicrobial therapy. After a follow-up of 117.1 (IQR, 62.5-235.5) weeks, 37 (26.1%) failures were observed: 16 (43.2%) infection persistence, three (8.1%) relapses, 22 (59.5%) superinfections and/or two (1.7%) infection-related deaths. Excluding superinfections, determinants of the 19 (13.4%) specific failures were an index craniectomy for brain tumor (odds ratio = 4.038, P = 0.033) and curettage of bone edges (odds ratio = 0.342, P = 0.048). CONCLUSION Post-craniectomy bone flap osteomyelitis are difficult-to-treat infection, necessitating prolonged antimicrobial therapy with appropriate surgical debridement, and advocating for multidisciplinary management in dedicated reference centers.
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Affiliation(s)
- Victor Dechaene
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France
| | - Clémentine Gallet
- Department of Neurosurgery D, Tumoral and Vascular Malformation Surgery Unit, Hospices Civils de Lyon, Lyon, France
| | - Sarah Soueges
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France
| | - Lannie Liu
- Department of Neurosurgery B, Skull Base Surgery Unit, Hospices Civils de Lyon, Lyon, France
| | - Violaine Delabar
- Department of Neurosurgery B, Skull Base Surgery Unit, Hospices Civils de Lyon, Lyon, France
| | - Léopold Adélaïde
- Department of Infectious Diseases, Lucien Husset Hospital, Vienne, France
| | - Sophie Jarraud
- 24/24 Microbiology Plateforme, Infectious Agent Institute, Centre de Biologie et Pathologie Nord, Hospices Civils de Lyon, Lyon, France; CIRI - Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Olivier Dauwalder
- 24/24 Microbiology Plateforme, Infectious Agent Institute, Centre de Biologie et Pathologie Nord, Hospices Civils de Lyon, Lyon, France; CIRI - Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Emmanuel Jouanneau
- Department of Neurosurgery B, Skull Base Surgery Unit, Hospices Civils de Lyon, Lyon, France
| | - Marie Wan
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France
| | - Timothée Jacquesson
- Department of Neurosurgery B, Skull Base Surgery Unit, Hospices Civils de Lyon, Lyon, France; Department of Anatomy, University of Lyon 1, Lyon, France; CREATIS Laboratory, CNRS UMR5220, Inserm U1044, INSA-Lyon, University of Lyon 1, Lyon, France
| | - Jacques Guyotat
- Department of Neurosurgery D, Tumoral and Vascular Malformation Surgery Unit, Hospices Civils de Lyon, Lyon, France
| | - Anne Conrad
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France; CIRI - Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Claire Triffault-Fillit
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France
| | - Tristan Ferry
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France; CIRI - Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Florent Valour
- Department of Infectious Diseases, Reference Center for the Management of Complex Bone and Joint Infections (CRIOAc, Lyon), Hospices Civils de Lyon, Lyon, France; CIRI - Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France.
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10
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Joerger AK, Laho X, Kehl V, Meyer B, Krieg SM, Ille S. The impact of intraoperative MRI on cranial surgical site infections-a single-center analysis. Acta Neurochir (Wien) 2023; 165:3593-3599. [PMID: 37971620 PMCID: PMC10739228 DOI: 10.1007/s00701-023-05870-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/14/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE The use of intraoperative MRI (ioMRI) contributes to an improved extent of resection. Hybrid operating room MRI suites have been established, with the patient being transferred to the MRI scanner. In the present descriptive analysis, we compared the rate of surgical site infections (SSI) after intracranial tumor surgery with and without the use of ioMRI. METHODS In this retrospective study, we included 446 patients with open craniotomy performed for brain tumor surgery. One hundred fourteen patients were operated on with the use of ioMRI between June 1, 2018, and June 30, 2019 (group 1). During the same period, 126 patients were operated on without ioMRI (group 2). As an additional control group, we analyzed 206 patients operated on from February 1, 2017, to February 28, 2018 when ioMRI had not yet been implemented (group 3). RESULTS The rate of SSI in group 1 (11.4%), group 2 (9.5%), and group 3 (6.8%) did not differ significantly (p = 0.352). Additional resection after ioMRI did not result in a significantly elevated number of SSI. No significant influence of re-resection, prior radio-/chemotherapy, blood loss or duration of surgery was found on the incidence of SSI. CONCLUSION Despite the transfer to a non-sterile MRI scanner, leading to a prolonged operation time, SSI rates with and without the use of ioMRI did not differ significantly. Hence, advantages of ioMRI outweigh potential disadvantages as confirmed by this real-life single-center study.
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Affiliation(s)
- Ann-Kathrin Joerger
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
| | - Xhimi Laho
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
| | - Victoria Kehl
- Institute for AI and Informatics in Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Sebastian Ille
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
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Pahwa B, Das S, Singh G, Anu MM. Association of predictive factors and neurosurgical postoperative infections: A retrospective analysis. Clin Neurol Neurosurg 2023; 232:107880. [PMID: 37454601 DOI: 10.1016/j.clineuro.2023.107880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To identify the factors that predispose neurosurgical patients to surgical site infections (SSI) as well as assess the risk factors attached to infection by a specific microorganism. METHODOLOGY A retrospective case-control study was conducted at University College of Medical Sciences and G.T.B. Hospital, Delhi. Adult patients (>18 years) undergoing a neurosurgical procedure with a diagnosis of SSI in the year 2021 having a minimum follow up of 30 days postoperatively or until death if they survived less than 30 days were included. Statistical analysis was performed using the SPSS 16 software with level of significance at 0.05. RESULTS An incidence of 3.15% was observed at our center. Mean age of the study population was 39.2 ± 13.07 years (range 22-70 years) with a male: female ratio of 3:1. Having an underlying infection (p = 0.024), ASA score> 2 (p = 0.041), duration of surgery> 4 h (p = 0.025), diabetes (p = 0.027) and preoperative stay at the hospital (p = 0.036) were found to be statistically significant risk factors in the prediction of SSI in neurosurgical patients which were utilised to create a regression model with an accuracy of 70% and AUC of 0.833. Deep infections were found to have a significant association with positive culture on the collected samples (p = 0.035). CONCLUSIONS This study is a starting point to identify which factors could predict the presence of a particular organism isolated from the site of infection in neurosurgical patients, thereby minimizing AMR.
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Affiliation(s)
- Bhavya Pahwa
- Medical Student, University College of Medical Sciences and GTB Hospital, Delhi, India.
| | - Shukla Das
- Department of Microbiology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Gurbachan Singh
- Department of Neurosurgery, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - M M Anu
- Department of Neurosurgery, University College of Medical Sciences and GTB Hospital, Delhi, India
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12
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Lv Y, Mao X, Deng Y, Yu L, Chu J, Hao S, Ji N. Surgical site infections after elective craniotomy for brain tumor: a study on potential risk factors and related treatments. Chin Neurosurg J 2023; 9:23. [PMID: 37553704 PMCID: PMC10408142 DOI: 10.1186/s41016-023-00336-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/21/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI) is a common complication following craniotomy that increases morbidity, mortality, and medical expenses. The objectives of this study were to determine the relevant risk factors associated with SSI after elective craniotomy for brain tumor and analyse the treatments for SSI. METHODS A retrospective nested case‒control study was conducted using data from patients who underwent craniotomy for brain tumor resection at the Neurosurgical Oncology Department No. 6 of Beijing Tiantan Hospital, Capital Medical University, between January 2019 and December 2021. Risk factors for SSI were determined using multivariate logistic regression analysis. We analyzed microbiological and related treatment data for different SSI types. RESULTS Among 2061 patients who underwent craniotomy for brain tumor, 31 had SSI (1.50%). In the multivariate logistic regression analysis, body mass index (BMI) and operative duration were identified as independent risk factors for SSI. The most common microorganism isolated from SSIs was Staphylococcus epidermidis (22.9%), and drug sensitivity results showed that gram-positive bacteria were sensitive to linezolid, vancomycin and tigecycline, whereas gram-negative bacteria were sensitive to meropenem, cefepime and ceftazidime. Six of the seven patients who underwent bone flap removal due to osteomyelitis were infected with gram-negative bacteria. CONCLUSIONS BMI and operative duration were identified as independent risk factors for SSI. Diabetes mellitus, previous ratio therapy, type of incision, recurrence tumor and other risk factors were not found to be associated with the occurrence of SSI in this study.
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Affiliation(s)
- Yifan Lv
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xiang Mao
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Yuxuan Deng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Lanbing Yu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Junsheng Chu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Shuyu Hao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
| | - Nan Ji
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
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Costabella F, Patel KB, Adepoju AV, Singh P, Attia Hussein Mahmoud H, Zafar A, Patel T, Watekar NA, Mallesh N, Fawad M, Sathyarajan DT, Abbas K. Healthcare Cost and Outcomes Associated With Surgical Site Infection and Patient Outcomes in Low- and Middle-Income Countries. Cureus 2023; 15:e42493. [PMID: 37637579 PMCID: PMC10455046 DOI: 10.7759/cureus.42493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
Surgical site infection (SSI) is a growing global concern. The principal explanation for this is its adverse clinical outcomes, such as morbidity and mortality. However, the link between the economic burden of SSIs and patient outcomes needs to be sufficiently characterized. This review aims to describe the financial implications of SSIs on patient outcomes in low- and middle-income countries (LMIC). Despite the heterogeneity in study designs from multiple LMIC countries, there is a significant correlation between SSI-associated healthcare costs from increased length of stay (LOS), readmissions, reoperations, and adverse patient outcomes. This varies based on the size, degree of infection, or other patient comorbidities. SSIs are much more prevalent in LMICs. The additional financial burden incurred in managing SSIs reinforces the need to prioritize practicing interventions to prevent this complication, which resource-limited health institutions are unequipped to do and consequently have significant adverse patient outcomes.
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Affiliation(s)
- Fernando Costabella
- Department of Pediatrics, Hospital General Dr. Manuel Gea Gonzalez, Mexico City, MEX
| | - Keval B Patel
- Department of Surgery, Narendra Modi Medical College, Ahmedabad, IND
| | | | - Purnima Singh
- College of Medicine, Gulf Medical University, Ajman, ARE
| | | | - Awais Zafar
- Department of Psychiatry, Sahiwal Medical College, Sahiwal, PAK
| | - Tirath Patel
- Department of Surgery, American University of Antigua, St. John, ATG
| | - Ninad A Watekar
- Department of Surgery, Davao Medical School Foundation, Davao, PHL
| | - Navya Mallesh
- Department of Surgery, St. Martinus University, Willemstad, CUW
| | - Moiz Fawad
- Department of Neurological Surgery, King Saud Hospital, Unaizah, SAU
| | - Dily T Sathyarajan
- Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bengaluru, IND
- Department of Surgery, Government Medical College, Thrissur, IND
| | - Kiran Abbas
- Department of Community Health Sciences, Aga Khan University, Karachi, PAK
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Rowse BM, Yu ACX, Faulkner H, Sandler G, Howle JR, Ch'ng S, Rao PJ, Varey AHR. Does preoperative imaging for scalp non-melanocytic skin cancer accurately predict invasion of the cranial vault? A systematic review and meta-analysis. ANZ J Surg 2023; 93:1970-1977. [PMID: 37303266 DOI: 10.1111/ans.18566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE This study aimed to determine the diagnostic accuracy of CT and MRI in the preoperative detection of bone involvement for non-melanoma skin cancers (NMSCs) located on the scalp. This study further aimed to evaluate the predictive value of these imaging modalities in determining the need for craniectomy and to identify gaps in the existing literature. METHODS Electronic searches of the MEDLINE, Embase, Cochrane and Google Scholar databases were performed for English language studies of any type. Studies reporting detection or exclusion of histopathologically confirmed bone involvement through preoperative imaging were identified according to PRISMA guidelines. Studies reporting dural involvement, non-scalp tumours, and lacking tumour type(s) or outcome data were excluded. Outcomes were preoperative imaging result and histopathologically confirmed bone invasion. Meta-analysis was performed and sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated (excluding case report and MRI data due to insufficient quality and quantity respectively). RESULTS Four studies with a total of 69 patients were included in the final review, of which two studies totalling 66 patients were included in the meta-analysis. Preoperative CT had a sensitivity of 38%, specificity of 98%, PPV of 90% and NPV of 73%. CONCLUSIONS The available data suggests that a preoperative CT finding of calvarial involvement by a scalp NMSC is likely to be real, but the absence of such a finding is unreliable. Current evidence suggests that preoperative imaging cannot exclude the necessity for craniectomy and future research is needed, particularly on the role of MRI.
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Affiliation(s)
- Benjamin M Rowse
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Ann C X Yu
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Harrison Faulkner
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Gideon Sandler
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Julie R Howle
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Sydney Ch'ng
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Department of Plastic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Sydney Head & Neck Cancer Institute, Chris O'Brien Lifehouse Cancer Institute, Sydney, New South Wales, Australia
| | - Prashanth J Rao
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, New South Wales, Australia
| | - Alexander H R Varey
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Department of Plastic Surgery, Westmead Hospital, Sydney, New South Wales, Australia
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15
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Sharma VJ, Adegoke JA, Afara IO, Stok K, Poon E, Gordon CL, Wood BR, Raman J. Near-infrared spectroscopy for structural bone assessment. Bone Jt Open 2023; 4:250-261. [PMID: 37051828 PMCID: PMC10079377 DOI: 10.1302/2633-1462.44.bjo-2023-0014.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
Aims Disorders of bone integrity carry a high global disease burden, frequently requiring intervention, but there is a paucity of methods capable of noninvasive real-time assessment. Here we show that miniaturized handheld near-infrared spectroscopy (NIRS) scans, operated via a smartphone, can assess structural human bone properties in under three seconds. Methods A hand-held NIR spectrometer was used to scan bone samples from 20 patients and predict: bone volume fraction (BV/TV); and trabecular (Tb) and cortical (Ct) thickness (Th), porosity (Po), and spacing (Sp). Results NIRS scans on both the inner (trabecular) surface or outer (cortical) surface accurately identified variations in bone collagen, water, mineral, and fat content, which then accurately predicted bone volume fraction (BV/TV, inner R2 = 0.91, outer R2 = 0.83), thickness (Tb.Th, inner R2 = 0.9, outer R2 = 0.79), and cortical thickness (Ct.Th, inner and outer both R2 = 0.90). NIRS scans also had 100% classification accuracy in grading the quartile of bone thickness and quality. Conclusion We believe this is a fundamental step forward in creating an instrument capable of intraoperative real-time use. Cite this article: Bone Jt Open 2023;4(4):250–261.
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Affiliation(s)
- Varun J. Sharma
- Department of Surgery, Melbourne Medical School, University of Melbourne, Melbourne, Australia
- Brian F. Buxton Department of Cardiac and Thoracic Aortic Surgery, Austin Hospital, Melbourne, Australia
- Spectromix Laboratory, Melbourne, Australia
| | - John A. Adegoke
- Spectromix Laboratory, Melbourne, Australia
- Centre for Biospectroscopy, Monash University, Melbourne, Australia
| | - Isaac O. Afara
- Spectromix Laboratory, Melbourne, Australia
- Centre for Biospectroscopy, Monash University, Melbourne, Australia
- Biomedical Spectroscopy Laboratory, Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- School of Information Technology and Electrical Engineering Faculty of Engineering, Architecture and Information Technology, Melbourne, Australia
| | - Kathryn Stok
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
| | - Eric Poon
- Spectromix Laboratory, Melbourne, Australia
- Department of Medicine, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Claire L. Gordon
- Department of Medicine, Melbourne Medical School, University of Melbourne, Melbourne, Australia
- Department of Infectious Diseases, Austin Hospital, Melbourne, Australia
| | - Bayden R. Wood
- Spectromix Laboratory, Melbourne, Australia
- Centre for Biospectroscopy, Monash University, Melbourne, Australia
| | - Jaishankar Raman
- Department of Surgery, Melbourne Medical School, University of Melbourne, Melbourne, Australia
- Brian F. Buxton Department of Cardiac and Thoracic Aortic Surgery, Austin Hospital, Melbourne, Australia
- Spectromix Laboratory, Melbourne, Australia
- Correspondence should be sent to Jaishankar Raman. E-mail:
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Maayan O, Tusa Lavieri ME, Babu C, Chua J, Christos PJ, Schwartz TH. Additive risk of surgical site infection from more than one risk factor following craniotomy for tumor. J Neurooncol 2023; 162:337-342. [PMID: 36988747 PMCID: PMC10953908 DOI: 10.1007/s11060-023-04294-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/10/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE This study seeks to expound upon risk factor etiologies for surgical site infection (SSI) and investigate their combinatorial effects on infection rate following craniotomy for neuro-oncologic pathology. METHODS Patients who underwent neuro-oncologic craniotomy between 2006 and 2020 were included. Medical records were reviewed to identify the occurrence of wound infection at ≤ 3 months postoperatively. Potential risk factors for infection included tumor pathology, location, anesthesia type, indication, ventricular entry, foreign body, brachytherapy, lumbar drain, prior operation, prior cranial radiation, prior infection, bevacizumab, and medical comorbidities (hypertension, obesity, diabetes, hyperlipidemia, other cancer, cirrhosis). Logistic regression was implemented to determine risk factors for SSI. Chi-square tests were used to assess whether the number of risk factors (e.g., 0, ≥ 1, ≥2, ≥ 3, ≥4) increases the risk of SSI compared to patients with fewer risk factors. The relative increase with each additional risk factor was also evaluated. RESULTS A total of 1209 patients were included. SSI occurred in 42 patients (3.5%) by 90 days after surgery. Significant risk factors on multivariate logistic regression were bevacizumab (OR 40.84; p < 0.001), cirrhosis (OR 14.20, p = 0.03), foreign body placement (OR 4.06; P < 0.0001), prior radiation (OR 2.20; p = 0.03), and prior operation (OR 1.92; p = 0.04). Infection rates in the combinatorial analysis were as follows: ≥1 risk factor = 5.9% (OR 2.74; p = 0.001), ≥ 2 = 6.7% (OR 2.28; p = 0.01), ≥ 3 = 19.0% (OR 6.5; p < 0.0001), ≥ 4 = 100% (OR 30.2; p < 0.0001). CONCLUSIONS Risk factors in aggregate incrementally increase the risk of postoperative SSI after craniotomy for tumor.
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Affiliation(s)
- Omri Maayan
- Weill Cornell Medical College, New York, NY, USA
| | | | | | - Jason Chua
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Paul J Christos
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Theodore H Schwartz
- Department of Neurological Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th St, Box #99, New York, NY, 10065, USA.
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Dastagirzada Y, Benjamin C, Bevilacqua J, Gurewitz J, Sen C, Golfinos JG, Placantonakis D, Jafar JJ, Lieberman S, Lebowitz R, Lewis A, Pacione D. Discontinuation of Postoperative Prophylactic Antibiotics for Endoscopic Endonasal Skull Base Surgery. J Neurol Surg B Skull Base 2023; 84:157-163. [PMID: 36895810 PMCID: PMC9991524 DOI: 10.1055/a-1771-0372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 01/24/2022] [Indexed: 10/19/2022] Open
Abstract
Background Postoperative prophylactic antibiotic usage for endoscopic skull base surgery varies based on the institution as evidence-based guidelines are lacking. The purpose of this study is to determine whether discontinuing postoperative prophylactic antibiotics in endoscopic endonasal cases led to a difference in central nervous system (CNS) infections, multi-drug resistant organism (MDRO) infections, or other postoperative infections. Methods This quality improvement study compared outcomes between a retrospective cohort (from September 2013 to March 2019) and a prospective cohort (April 2019 to June 2019) after adopting a protocol to discontinue prophylactic postoperative antibiotics in patients who underwent endoscopic endonasal approaches (EEAs). Our primary end points of the study included the presence of postoperative CNS infection, Clostridium difficile ( C. diff ), and MDRO infections. Results A total of 388 patients were analyzed, 313 in the pre-protocol group and 75 in the post-protocol group. There were similar rates of intraoperative cerebrospinal fluid leak (56.9 vs. 61.3%, p = 0.946). There was a statistically significant decrease in the proportion of patients receiving IV antibiotics during their postoperative course ( p = 0.001) and those discharged on antibiotics ( p = 0.001). There was no significant increase in the rate of CNS infections in the post-protocol group despite the discontinuation of postoperative antibiotics (3.5 vs. 2.7%, p = 0.714). There was no statistically significant difference in postoperative C. diff (0 vs. 0%, p = 0.488) or development of MDRO infections (0.3 vs 0%, p = 0.624). Conclusion Discontinuation of postoperative antibiotics after EEA at our institution did not change the frequency of CNS infections. It appears that discontinuation of antibiotics after EEA is safe.
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Affiliation(s)
- Yosef Dastagirzada
- Department of Neurosurgery, NYU Langone Health, New York, New York, United States
| | - Carolina Benjamin
- Department of Neurosurgery, University of Miami, Miami, Florida, United States
| | - Julia Bevilacqua
- Department of Neurosurgery, NYU Langone Health, New York, New York, United States
| | - Jason Gurewitz
- Department of Neurosurgery, NYU Langone Health, New York, New York, United States
| | - Chandra Sen
- Department of Neurosurgery, NYU Langone Health, New York, New York, United States
| | - John G Golfinos
- Department of Neurosurgery, NYU Langone Health, New York, New York, United States
| | | | - Jafar J Jafar
- Department of Neurosurgery, NYU Langone Health, New York, New York, United States
| | - Seth Lieberman
- Department of Otolaryngology, NYU Langone Health, New York, New York, United States
| | - Rich Lebowitz
- Department of Otolaryngology, NYU Langone Health, New York, New York, United States
| | - Ariane Lewis
- Department of Neurosurgery, NYU Langone Health, New York, New York, United States.,Department of Neurology, NYU Langone Health, New York, New York, United States
| | - Donato Pacione
- Department of Neurosurgery, NYU Langone Health, New York, New York, United States
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18
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O’Donnell S, Creedon M, Walsh J, Dinesh B, O’Brien D, MacNally S, Humphreys H. Bone flap infections after craniotomy. A review of 63 cases and the implications for definitions, classification and surveillance methodologies. J Hosp Infect 2023; 136:14-19. [PMID: 37004785 DOI: 10.1016/j.jhin.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Bone flap infections (BFI) occur following neurosurgical procedures such as craniotomies. However, they are poorly defined and often not clearly differentiated from other surgical site infection neurosurgery. AIM To review data from a national adult neurosurgical centre to explore some clinical aspects to better inform definitions, classification and surveillance methodologies. METHODS We retrospectively reviewed data on clinical samples sent for culture from patients with suspected BFI. We also accessed information recorded prospectively from national and local databases for evidence of BFI or related conditions based upon terms used in surgical operative notes or discharge summaries and documented monomicrobial and polymicrobial infections related to craniotomy sites. FINDINGS Between January 2016 and December 2020, we documented 63 patients with a mean age of 45 years (16-80). Craniectomy for infection of the skull was the most common terminology used to describe BFI in the coding used in a national database, 40/63 (63%), but other terms were used. A malignant neoplasm was the most common underlying condition necessitating craniectomy in 28/63 (44%) cases. Specimens submitted for microbiological investigation included 48/63 (76%) bone flaps, 38/63 (60%) fluid/pus, and 29/63 (46%) tissue. Fifty-eight (92%) patients had at least one culture positive specimen; 32 (55%) were monomicrobial and 26 (45%) were polymicrobial. Gram-positive bacteria predominated and Staphylococcus aureus was the most common. CONCLUSION Greater clarity on how to define BFI is required to enable better classification and the carrying out of appropriate surveillance. This will inform preventative strategies and more effective patient management.
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Sakata T, Tanikawa M, Yamada H, Fujinami R, Nishikawa Y, Yamada S, Mase M. Minimally invasive treatment for glioblastoma through endoscopic surgery including tumor embolization when necessary: a technical note. Front Neurol 2023; 14:1170045. [PMID: 37153685 PMCID: PMC10160401 DOI: 10.3389/fneur.2023.1170045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/03/2023] [Indexed: 05/10/2023] Open
Abstract
Background Although there have been some reports on endoscopic glioblastoma surgery, the indication has been limited to deep-seated lesions, and the difficulty of hemostasis has been a concern. In that light, we attempted to establish an endoscopic procedure for excision of glioblastoma which could be applied even to hypervascular or superficial lesions, in combination with pre-operative endovascular tumor embolization. Methods Medical records of six consecutive glioblastoma patients who received exclusive endoscopic removal between September and November 2020 were analyzed. Preoperative tumor embolization was performed in cases with marked tumor stain and proper feeder arteries having an abnormal shape, for instance, tortuous or dilated, without passing through branches to the normal brain. Endoscopic tumor removal through a key-hole craniotomy was performed by using an inside-out excision for a deep-seated lesion, with the addition of an outside-in extirpation for a shallow portion when needed. Results Endoscopic removal was successfully performed in all six cases. Before resection, endovascular tumor embolization was performed in four cases with no resulting complications, including ischemia or brain swelling. Gross total resection was achieved in three cases, and near total resection in the other three cases. Intraoperative blood loss exceeded 1,000 ml in only one case, whose tumor showed a prominent tumor stain but no proper feeder artery for embolization. In all patients, a smooth transition to adjuvant therapy was possible with no surgical site infection. Conclusion Endoscopic removal for glioblastoma was considered to be a promising procedure with minimal invasiveness and a favorable impact on prognosis.
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Zeng X, Yang B, Zhang B, Xu B, Rong C, She J, Guo W, Kong J, Liu Y, Zhao D, Xu X. A meta‐analysis examined the effect of intrawound vancomycin on surgical site wound infections in non‐spinal neurosurgical operation. Int Wound J 2022; 20:1584-1590. [PMID: 36424840 PMCID: PMC10088818 DOI: 10.1111/iwj.14014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/26/2022] Open
Abstract
To assess the impact of intrawound vancomycin on surgical site wound infections in non-spinal neurosurgical operations, we conducted a meta-analysis. A thorough review of the literature up to September 2022 showed that 4286 participants had a non-spinal neurosurgical operation at the start of the investigations; 1975 of them used intrawound vancomycin, while 2311 were control. Using dichotomous or contentious methods and a random or fixed-effect model, odds ratios (OR) and mean difference (MD) with 95% confidence intervals (CIs) were estimated to evaluate the impact of intrawound vancomycin on surgical site wound infections in non-spinal neurosurgical operation. The intrawound vancomycin had significantly lower surgical site wound infections (OR, 0.28; 95% CI, 0.19-0.40; P < .001) with low heterogeneity (I2 = 32%) compared with the control in non-spinal neurosurgical operation. The intrawound vancomycin had significantly lower surgical site wound infections compared with control in non-spinal neurosurgical operation. The low sample size of 2 out of 13 researches in the meta-analysis calls for care when analysing the results.
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Affiliation(s)
- Xiangwu Zeng
- Department of Brain The Second People's Hospital of Zhangye City Zhangye Gansu China
| | - Bo Yang
- Department of Pharmacy The Second People's Hospital of Zhangye City Zhangye Gansu China
| | - Baiming Zhang
- Department of Pharmacy The Second People's Hospital of Zhangye City Zhangye Gansu China
| | - Buxuan Xu
- Department of Brain The Second People's Hospital of Zhangye City Zhangye Gansu China
| | - Congxue Rong
- Department of Brain The Second People's Hospital of Zhangye City Zhangye Gansu China
| | - Jianhu She
- Department of Brain The Second People's Hospital of Zhangye City Zhangye Gansu China
| | - Wanliang Guo
- Department of Brain The Second People's Hospital of Zhangye City Zhangye Gansu China
| | - Jianlong Kong
- Department of Brain The Second People's Hospital of Zhangye City Zhangye Gansu China
| | - Yangzi Liu
- Department of Brain The Second People's Hospital of Zhangye City Zhangye Gansu China
| | - Dianfan Zhao
- Department of Brain The Second People's Hospital of Zhangye City Zhangye Gansu China
| | - Xiuzhen Xu
- Department of Pharmacy The Second People's Hospital of Zhangye City Zhangye Gansu China
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Pan SJ, Hou Y, Yang YP, Wang GG, Chen XY, Qian WY, Tung TH, Hu XM. Relationship between nosocomial infections and coronavirus disease 2019 in the neurosurgery unit: clinical characteristics and outcomes from a Chinese Tertiary-Care Hospital. BMC Infect Dis 2022; 22:836. [PMID: 36368929 PMCID: PMC9651116 DOI: 10.1186/s12879-022-07845-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background The COVID-19 pandemic has raised awareness of infection prevention and control. We found that the incidence of nosocomial infection in neurosurgery has changed. This study aimed to evaluate the impact of “coronavirus disease 2019 (COVID-19) prevention and control measures” on nosocomial infections in neurosurgery. Methods To explore changes in nosocomial infections in neurosurgery during the COVID-19 pandemic, the clinical data of inpatients undergoing neurosurgery at Taizhou Hospital of Zhejiang Province between January 1 and April 30, 2020 (COVID-19 era) were first analyzed and then compared with those from same period in 2019 (first pre-COVID-19 era). We also analyzed data between May 1 and December 31, 2020 (post-COVID-19 era) at the same time in 2019 (second pre-COVID-19 era). Results The nosocomial infection rate was 7.85% (54/688) in the first pre-COVID-19 era and 4.30% (26/605) in the COVID-19 era (P = 0.01). The respiratory system infection rate between the first pre-COVID-19 and COVID-19 eras was 6.1% vs. 2.0% (P < 0.01), while the urinary system infection rate was 1.7% vs. 2.0% (P = 0.84). Between the first pre-COVID-19 and COVID-19 eras, respiratory system and urinary infections accounted for 77.78% (42/54) vs. 46.15% (12/26) and 22.22% (12/54) vs. 46.15% (12/26) of the total nosocomial infections, respectively (P < 0.01). Between the second pre-COVID-19 and post-COVID-19 eras, respiratory system and urinary accounted for 53.66% (44/82) vs. 40.63% (39/96) and 24.39% (20/82) vs. 40.63% (39/96) of the total nosocomial infections, respectively (P = 0.02). Conclusions The incidence of nosocomial infections in neurosurgery reduced during the COVID-19 pandemic. The reduction was primarily observed in respiratory infections, while the proportion of urinary infections increased significantly.
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22
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Nair SK, Botros D, Chakravarti S, Mao Y, Wu E, Lu B, Liu S, Elshareif M, Jackson CM, Gallia GL, Bettegowda C, Weingart J, Brem H, Mukherjee D. Predictors of surgical site infection in glioblastoma patients undergoing craniotomy for tumor resection. J Neurosurg 2022; 138:1227-1234. [PMID: 36208433 DOI: 10.3171/2022.8.jns212799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 08/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Surgical site infections (SSIs) burden patients and healthcare systems, often requiring additional intervention. The objective of this study was to identify the relationship between preoperative predictors inclusive of scalp incision type and postoperative SSI following glioblastoma resection.
METHODS
The authors retrospectively reviewed cases of glioblastoma resection performed at their institution from December 2006 to December 2019 and noted preoperative demographic and clinical presentations, excluding patients missing these data. Preoperative nutritional indices were available for a subset of cases. Scalp incisions were categorized as linear/curvilinear, reverse question mark, trapdoor, or frontotemporal. Patients were dichotomized by SSI incidence. Multivariable logistic regression was used to determine predictors of SSI.
RESULTS
A total of 911 cases of glioblastoma resection were identified, 30 (3.3%) of which demonstrated postoperative SSI. There were no significant differences in preoperative malnutrition or number of surgeries between SSI and non-SSI cases. The SSI cases had a significantly lower preoperative Karnofsky Performance Status (KPS) than the non-SSI cases (63.0 vs 75.1, p < 0.0001), were more likely to have prior radiation history (43.3% vs 26.4%, p = 0.042), and were more likely to have received steroids both preoperatively and postoperatively (83.3% vs 54.5%, p = 0.002). Linear/curvilinear incisions were more common in non-SSI than in SSI cases (56.9% vs 30.0%, p = 0.004). Trapdoor scalp incisions were more frequent in SSI than non-SSI cases (43.3% vs 24.2%, p = 0.012). On multivariable analysis, a lower preoperative KPS (OR 1.04, 95% CI 1.02–1.06), a trapdoor scalp incision (OR 3.34, 95% CI 1.37–8.49), and combined preoperative and postoperative steroid administration (OR 3.52, 95% CI 1.41–10.7) were independently associated with an elevated risk of postoperative SSI.
CONCLUSIONS
The study findings indicated that SSI risk following craniotomy for glioblastoma resection may be elevated in patients with a low preoperative KPS, a trapdoor scalp incision during surgery, and steroid treatment both preoperatively and postoperatively. These data may help guide future operative decision-making for these patients.
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Affiliation(s)
- Sumil K. Nair
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David Botros
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sachiv Chakravarti
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yuncong Mao
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Esther Wu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian Lu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sophie Liu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mazin Elshareif
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher M. Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gary L. Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jon Weingart
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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23
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Zhang *Y, Tan H, Jia L, He J, Hao P, Li T, Xiao Y, Peng L, Feng Y, Cheng X, Deng H, Wang P, Chong W, Hai Y, Chen L, You C, Fang F. Association of preoperative glucose concentration with mortality in patients undergoing craniotomy for brain tumor. J Neurosurg 2022; 138:1254-1262. [PMID: 36308478 DOI: 10.3171/2022.9.jns221251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Hyperglycemia is associated with worse outcomes in ambulatory settings and specialized hospital settings, but there are sparse data on the importance of preoperative blood glucose measurement before brain tumor craniotomy. The authors sought to investigate the association between preoperative glucose level and 30-day mortality rate in patients undergoing brain tumor resection.
METHODS
This retrospective cohort study included patients undergoing craniotomy for brain tumors at West China Hospital, Sichuan University, from January 2011 to March 2021. Surgical mortality rates were evaluated in patients who had normal glycemia (< 5.6 mmol/L) as well as mild (5.6–6.9 mmol/L), moderate (7.0–11.0 mmol/L), and severe hyperglycemia (> 11.0 mmol/L).
RESULTS
The study included 12,281 patients who underwent tumor resection via craniotomy. The overall 30-day mortality rate was 2.0% (242/12,281), whereas the rates for normal glycemia and mild, moderate, and severe hyperglycemia were 1.5%, 2.5%, 3.8%, and 6.5%, respectively. Compared with normal glycemia, the odds of mortality at 30 days were higher in patients with mild hyperglycemia (adjusted odds ratio [OR] 1.44, 95% confidence interval [CI] 1.05–2.00), moderate hyperglycemia (OR 2.04, 95% CI 1.41–2.96), and severe hyperglycemia (OR 3.76, 95% CI 1.96–7.20; p < 0.001 for trend). When blood glucose was analyzed as a continuous variable, for each 1 mmol/L increase in blood glucose, the adjusted OR of 30-day mortality was 1.13 (95% CI 1.08–1.19). The addition of a preoperative glucose level significantly improved the area under the curve and categorical net reclassification index for prediction of mortality.
CONCLUSIONS
In patients undergoing craniotomy for brain tumors, even mild hyperglycemia was associated with an increased mortality rate, at a glucose level that was much lower than the commonly applied level.
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Affiliation(s)
- *Yu Zhang
- Departments of Neurosurgery and
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan
| | - Huiwen Tan
- Endocrinology, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Lu Jia
- Department of Neurosurgery, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi
| | - Jialing He
- Departments of Neurosurgery and
- Department of Neurosurgery, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong
| | - Pengfei Hao
- Department of Neurosurgery, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi
| | - Tiangui Li
- Department of Neurosurgery, Longquan Hospital, Chengdu, Sichuan, China
| | - Yangchun Xiao
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan
| | - Liyuan Peng
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan
| | - Yuning Feng
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan
| | | | - Haidong Deng
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan
| | - Peng Wang
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan
| | - Weelic Chong
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia; and
| | - Yang Hai
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lvlin Chen
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan
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24
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Wu Y, Zhang Y, Wu Y, Zhu G, Xue Y, Qu Y, Zhao T. Postoperative Early Lumbar Drainage Can Reduce the Duration of Fever or Infection in Patients with Complicated Intracranial Tumors after a Long Operation Time. Neurol India 2022; 70:1435-1442. [PMID: 36076640 DOI: 10.4103/0028-3886.355097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Intracranial fever or infection is one of the common complications after craniotomy, especially for complicated intracranial tumors such as deep skull base tumors. Objective We used early cerebrospinal fluid (CSF) drainage with a preplaced lumbar drainage (LD) tube after surgery and observed whether this procedure could reduce the rate and duration of fever or infection. Material and Methods The authors conducted a retrospective study of 142 patients who underwent complicated intracranial tumor surgery with no less than four hours of dural opening at the Center of Neurosurgery of Tangdu Hospital. The LD group underwent preoperative LD placement, intraoperative CSF release and postoperative continuous drainage, but the control group received routine craniotomy without preoperative LD. The primary outcomes included the rate, duration, and hospital length of stay (LOS) for patients with fever or infection after surgery, as compared between the two groups. The second outcome included complications related to LD and the rate of postoperative CSF leakage. Results There were 22 patients in the LD group and 23 patients in the control group who presented with delayed fever, which was supposed to be caused by intracranial infection or aseptic inflammation. The median duration of delayed fever in the LD group was obviously lower than that in the control group (7.762 ± 3.129 days vs 11.73 ± 5.239 days), and there was a statistically significant difference (P = 0.0046). In addition, there was a significant reduction in the median postoperative LOS (12 [8,10,15,21] days in the LD group vs 15 [9,13,20,28] days in the controls). Moreover, there was no significant difference in complications related to LD between the two groups. Three patients with brain herniation were observed in the LD group compared with one patient in the control group. All four patients had contemporary mild-to-moderate neurologic disorders after surgery or conservative treatment. Additionally, the rate of CSF leakage in the LD group was 5.41% (4/74), which was lower than that in the control group (8/68, [11.76%]), although there was no significant difference (P = 0.174). Conclusions For patients receiving complicated intracranial lesions following a long operation time, postoperative early LD was beneficial for the treatment of patients with fever or infection. It not only reduced the duration of infection or fever in postoperative patients but also decreased the postoperative LOS. We should minimize the complications related to LD by careful and standardized LD and management processes, and ensure the effectiveness and safety of this treatment.
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Affiliation(s)
- Yingxi Wu
- Department of Neurosurgery, Tangdu Hospital, The Air Force Medical University, Xi'an, China
| | - Yunze Zhang
- Department of Neurosurgery, Tangdu Hospital, The Air Force Medical University, Xi'an, China
| | - Yang Wu
- Department of Neurosurgery, Tangdu Hospital, The Air Force Medical University, Xi'an, China
| | - Gang Zhu
- Department of Neurosurgery, Tangdu Hospital, The Air Force Medical University, Xi'an, China
| | - Yafei Xue
- Department of Neurosurgery, Tangdu Hospital, The Air Force Medical University, Xi'an, China
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital, The Air Force Medical University, Xi'an, China
| | - Tianzhi Zhao
- Department of Neurosurgery, Tangdu Hospital, The Air Force Medical University, Xi'an, China
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25
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Rubiñán P, Pérez-Rodríguez MT, Domínguez A, Sousa A, Lima O, Rubianes M, Conde C, Álvarez-Fernández M. Oral sequential therapy in the treatment of post-surgical epidural abscess and subdural empyema. Infection 2022; 50:1385-1389. [PMID: 35460496 DOI: 10.1007/s15010-022-01814-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/22/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The management of post-surgical subdural empyema and subdural abscess is not standardised. The objective was to analyse the efficacy and safety of oral sequential therapy (OST). METHODS Retrospective observational study in a tertiary hospital in Vigo (Spain). We included adult patients with subdural abscess or epidural empyema with microbiological isolation. Clinical and demographic variables, isolated microorganisms and treatment regimens were included, as well as mortality and adverse effects during the follow-up period. RESULTS Thirty patients were reviewed, two died due to causes other than infection. Six-month recurrence rate was 2/28 and all other patients (26/28) had clinical cure at the end of the treatment. The commonest isolated microorganisms were Gram-positive, especially Staphylococcus aureus. The most widely used oral antibiotic was trimethoprim-sulfamethoxazole (80%). No side effects related to oral treatment were observed. CONCLUSION After adequate source control, OST can be a safe practice in the management of post-surgical epidural abscess and subdural empyema.
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Affiliation(s)
- Pablo Rubiñán
- Infectious Diseases Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Vigo, Estrada Clara Campoamor, 341, 36213, Vigo Pontevedra, Spain
| | - María Teresa Pérez-Rodríguez
- Infectious Diseases Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Vigo, Estrada Clara Campoamor, 341, 36213, Vigo Pontevedra, Spain. .,Biomedical Research Institute Galicia Sur, Vigo, Spain.
| | - Antía Domínguez
- Neurosurgical Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Adrián Sousa
- Infectious Diseases Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Vigo, Estrada Clara Campoamor, 341, 36213, Vigo Pontevedra, Spain.,Biomedical Research Institute Galicia Sur, Vigo, Spain
| | - Olalla Lima
- Infectious Diseases Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Vigo, Estrada Clara Campoamor, 341, 36213, Vigo Pontevedra, Spain.,Biomedical Research Institute Galicia Sur, Vigo, Spain
| | - Martín Rubianes
- Infectious Diseases Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Vigo, Estrada Clara Campoamor, 341, 36213, Vigo Pontevedra, Spain
| | - Cesáreo Conde
- Neurosurgical Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Maximiliano Álvarez-Fernández
- Biomedical Research Institute Galicia Sur, Vigo, Spain.,Microbiological Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
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26
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Berghmans M, de Ghellinck L, De Greef J, Di Santo M, Ribeiro Vaz JG, Zech F, Belkhir L. Outcome of Patients with Surgical Site Infection after Craniotomy. Surg Infect (Larchmt) 2022; 23:388-393. [PMID: 35333641 DOI: 10.1089/sur.2021.260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The management of surgical site infection (SSI) after craniotomy remains challenging with few existing recommendations. Patients and Methods: We reviewed the medical files of patients who underwent surgery between 2009 and 2018 to manage infection after craniotomy at our tertiary hospital. The Cox proportional hazards model and the Renyi test were used to investigate the association between relapse or all-cause mortality and selected variables. We compared infections with and without intra-cranial involvement using the Fisher test and the Wilcoxon rank sum test. Results: Seventy-seven episodes of infection were identified in 58 patients. The proportion of relapse was estimated to be 32.2% (± standard deviation [SD] 6.9) at five years. Intra-cranial infection was present in 15.6% of the cases (n = 12). Bone flap was removed in the majority of cases (93.5%) and the overall median duration of antibiotic therapy was six weeks (interquartile range [IQR] 6-12 weeks). Staphylococcus aureus was associated with a higher risk of relapse (p = 0.037). The administration of parenteral antibiotic agents (p = 0.012) and bone flap removal (p = 0.0051) were correlated with less relapse. In contrast, immunosuppressive drug use and radiotherapy were correlated with a higher risk of relapse (p = 0.014 and p = 0.031, respectively) and a higher all-cause mortality (p = 0.0093 and p < 0.0001, respectively). We found no difference between infections with and without intra-cranial involvement. Conclusions: Bone flap removal and parenteral antibiotic agents remain important in the management of SSI after craniotomy and were associated with less relapse in our study. More studies are needed to better determine the optimal treatment of this infection.
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Affiliation(s)
- Mathilde Berghmans
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Léopold de Ghellinck
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Julien De Greef
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Melissa Di Santo
- Department of Neurosurgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Francis Zech
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Leïla Belkhir
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
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27
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Cediel EG, Boerwinkle VL, Ramon JF, Arias D, De la Hoz-Valle JA, Mercado JD, Cohen D, Niño MC. Length of preoperative hospital stay is the dominating risk factor for surgical site infection in neurosurgery: A cohort data-driven analysis. Surg Neurol Int 2022; 13:80. [PMID: 35399909 PMCID: PMC8986656 DOI: 10.25259/sni_1237_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/14/2022] [Indexed: 11/04/2022] Open
Abstract
Background: The number of days of preoperative hospital stay (PHS) is a modifiable variable that has shown contradictory surgical site infection (SSI) risk factor results in neurosurgery. We sought to pinpoint the day of PHS length related with a marked increase of risk of SSI. Methods: From a tertiary teaching hospital, January 2015–December 2017, prospectively collected nonpercutaneous neurosurgery procedures with standard antibiotic prophylaxis and 1-year follow-up were evaluated. SSI risk factors were assessed through multiple logistic regression models with different thresholds of PHS. Results: A total of 1012 procedures were included in the study. Incidence of SSI was 4.4%. The median PHS was higher in those with SSI than in those without (1 day, interquartile range [IQR]: 7 vs. 0 days, IQR: 1, respectively, P = 0.002). By the amount of six days of PHS, this exposure risk past the threshold of significance for impact on wound infection (OR 2.8; CI 1.23–6.39, P = 0.014). Operative time past 4 h (OR 2.11; CI 1.12-3.98; P = 0.021), and in some models, previous surgery at same admission were also identified by multivariate analysis as increasing postoperative SSI risk. Conclusion: The gradual increase of the SSI OR associated with longer PHS days was the highest risk factor of SSI in our cohort of patients. Studies directed to reduce this complication should consider the PHS.
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Affiliation(s)
- Emilio Garzón Cediel
- Department of Neurosurgery, Clínica de Marly Jorge Cavelier Gaviria, Chía, Cundinamarca, Colombia, United States,
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Varina Louise Boerwinkle
- Department of Pediatric Neurology, Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, Arizona, United States,
| | - Juan Fernando Ramon
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Diana Arias
- Department of Anesthesiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Jose Antonio De la Hoz-Valle
- Department of Clinical Research, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Jose Dario Mercado
- Department of Anesthesiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Darwin Cohen
- Department of Anesthesiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Maria Claudia Niño
- Department of Anesthesiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Cundinamarca, Colombia
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28
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Ribeiro BB, Pereira RD, Vaz R, Carvalho B, Pereira NR. Nonemergent craniotomy surgical site infection: a retrospective cohort study. Porto Biomed J 2022; 7:e152. [PMID: 38304161 PMCID: PMC10830068 DOI: 10.1097/j.pbj.0000000000000152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 03/20/2021] [Indexed: 11/26/2022] Open
Abstract
Background The incidence of surgical site infection after craniotomy (SSI-CRAN) varies widely and is associated with major consequences. The aim of this study is to estimate the SSI-CRAN rate at the neurosurgery department of a tertiary center and to establish its risk factors. Methods All consecutive adult patients who underwent elective craniotomy for tumor resection at a tertiary center from January 2018 to October 2019 were retrospectively assessed. Demographic, clinical, and surgical data were collected. The main outcome of our study was the development of SSI within 30days postsurgery, as defined by the European Centre for Disease Prevention and Control guidelines. Univariate and multivariate analyses were performed to establish risk factors for SSI-CRAN. Results From the 271 patients enrolled in this study, 15 (5.5%) developed SSI-CRAN within 30days postsurgery, 11 (73.3%) of which were organ-space. The most common causative microorganisms isolated were gram-positive cocci, particularly Staphylococcus epidermidis (n = 4, 66.7%). In the univariate analysis, absence of normothermia and cerebrospinal fluid (CSF) leak were associated with SSI-CRAN. In the multivariate analysis, normothermia was the only protective factor and CSF leak was the only independent risk factor for SSI-CRAN. Conclusion The cumulative incidence of SSI-CRAN within 30days postsurgery was 5.5%. CSF leak and the absence of normothermia were the only independent risk factors for SSI-CRAN. The data provided in this study should be considered in the design of preventive strategies aimed to reduce the incidence of SSI.
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Affiliation(s)
| | - Raquel Duro Pereira
- Antimicrobial Resistance and Infection Prevention and Control Unit, Epidemiology Centre, Centro Hospitalar Universitário São João
- Infectious Diseases Department, Centro Hospitalar Universitário São João
| | - Rui Vaz
- Faculty of Medicine, University of Porto
- Neurosurgery Department, Centro Hospitalar Universitário São João
- Neurosciences Centre, CUF Hospital
| | - Bruno Carvalho
- Faculty of Medicine, University of Porto
- Neurosurgery Department, Centro Hospitalar Universitário São João
| | - Nuno Rocha Pereira
- Antimicrobial Resistance and Infection Prevention and Control Unit, Epidemiology Centre, Centro Hospitalar Universitário São João
- Infectious Diseases Department, Centro Hospitalar Universitário São João
- Medicine Department, Faculty of Medicine, University of Porto, Porto, Portugal
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29
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Wathen C, Yang AI, Hitti FL, Henry L, Chaibainou H, Baltuch GH. Feasibility of Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Essential Tremor in the Setting of Prior Craniotomy. Oper Neurosurg (Hagerstown) 2022; 22:61-65. [PMID: 35007218 DOI: 10.1227/ons.0000000000000012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging-guided focused ultrasound (MRgFUS) thalamotomy is a rapidly evolving therapy for the treatment of essential tremor. Although the skull is a major determinant of the delivery of acoustic energy to the target, how the presence of a prior craniotomy must be accounted for during lesioning is unclear. OBJECTIVE To demonstrate novel application of this therapeutic option in a patient with a history of prior craniotomies for unrelated intracranial pathologies. METHODS A 55-yr-old man with a history of right frontal craniotomy for resection of a colloid cyst underwent a left ventrointermedius nucleus thalamotomy through MRgFUS. The prior craniotomy flap was not excluded in the treatment plan; however, all bony defects and hardware were marked as "no-pass" regions. Clinical outcomes were collected at the 6-mo follow-up. RESULTS Transducer elements whose acoustic paths would have been altered by the craniotomy defect were turned off. Sonications reaching lesional temperatures of up to 56°C were successfully delivered. The procedure was well-tolerated, without any persistent intra-ablation or postablation adverse effects. The presence of a lesion was confirmed on MRI, which was associated with a significant reduction in the patient's tremor that was sustained at the 6-mo follow-up. CONCLUSION This case demonstrates the safety and efficacy of MRgFUS thalamotomy in a patient with prior craniotomies and highlights our strategy for acoustic lesioning in this setting.
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Affiliation(s)
- Connor Wathen
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew I Yang
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frederick L Hitti
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Hanane Chaibainou
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gordon H Baltuch
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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30
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Overview and risk factors for postcraniotomy surgical site infection: A four-year experience. ANTIMICROBIAL STEWARDSHIP AND HEALTHCARE EPIDEMIOLOGY 2022; 2:e14. [PMID: 36310773 PMCID: PMC9615103 DOI: 10.1017/ash.2021.258] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 12/02/2022]
Abstract
Objective: Despite evidence favoring perioperative antibiotic prophylaxis (ABP) use in patients undergoing craniotomy to reduce rates of surgical site infections (SSIs), standardized protocols are lacking. We describe demographic characteristics, risk factors, and ABP choice in patients with craniotomy complicated with SSI. Design: Retrospective case series from January 1, 2017, through December 31, 2020. Setting: Tertiary-care referral center. Patients: Adults who underwent craniotomy and were diagnosed with an SSI. Methods: Logistic regression to estimate odds ratios and 95% confidence intervals to identify factors associated with SSIs. Results: In total, 5,328 patients undergoing craniotomy were identified during the study period; 59 (1.1%) suffered an SSI. Compared with non-SSI cases, patients with SSI had a significantly higher frequency of emergency procedures: 13.5% versus 5.8% (P = .02; odds ratio [OR], 2.52; 95% confidene interval [CI], 1.10–5.06; P = .031). Patients with SSI had a higher rate of a dirty (5.1% vs 0.9%) and lower rate of clean-contaminated (3.3% vs 14.5%) wound class than those without infection (P = .002). Nearly all patients received ABP before craniotomy (98.3% in the SSI group vs 99.6% in the non-SSI group; P = .10). Combination of vancomycin and cefazolin as dual therapy was more prevalent in the group of patients without infection (n = 1,761, 34.1%) than those with SSI (n = 4, 6.8%) (P < .001), associated with decreased odds for SSI (OR, 0.17; 95% CI, 0.005–0.42; P ≤ .001). Conclusions: SSI are frequently seen after an emergent neurosurgical procedure and a dirty wound classification. Combination of prophylactic cefazolin and vancomycin is associated with decreased risk for SSI.
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Atallah A, Elbaroody M, Hassan AAAN, Ali AM, Elhawary ME. Role of topical vancomycin in reduction of postoperative infections in head trauma patients: A developing country experience. Surg Neurol Int 2021; 12:600. [PMID: 34992917 PMCID: PMC8720444 DOI: 10.25259/sni_640_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 11/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Postoperative cranial wound infections are a major cause of morbidity, mortality, and financial burden, especially in developing countries. Methods: We prospectively studied 86 patients in a randomized trial; 39 patients received one gram of topical vancomycin powder in the subgaleal space while 47 matched control patients did not. Both groups received identical intraoperative and post-operative care. The primary outcome variable was the postoperative wound infections rate factored by cohort. Secondary outcomes were the timing of infection and the rate of adverse events. Results: Adding topical vancomycin was associated with a significantly lower rate of infection than the standard of care alone (2.6% [1/39] vs. 14.9% [7/47], P =.004). No adverse reactions occurred. Conclusion: Topical vancomycin is safe, and effective in the prevention of surgical site infections following craniotomy. These findings have broad consequences for neurosurgery practice, especially in developing countries with high incidence of head trauma.
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Affiliation(s)
- Ahmed Atallah
- Department of Neurosurgery, Cairo University Hospitals, Cairo University, Cairo, Egypt
| | - Mohammad Elbaroody
- Department of Neurosurgery, Cairo University Hospitals, Cairo University, Cairo, Egypt
| | | | - Ahmed M. Ali
- Department of Neurosurgery, Cairo University Hospitals, Cairo University, Cairo, Egypt
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Coelho E, Costa L, Martins J, Costa M, Oliveira JE, Maia-Gonçalves A, Lencastre L. Healthcare-Associated Ventriculitis and Meningitis: A Retrospective Analysis. Cureus 2021; 13:e19069. [PMID: 34849306 PMCID: PMC8617354 DOI: 10.7759/cureus.19069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/05/2022] Open
Abstract
Background and objective Healthcare-associated ventriculitis and meningitis (HAVM) is frequent in neurocritical patients and associated with significant mortality. Surgery and intracranial devices are usually necessary and may lead to infection. Classical clinical signs and cerebral spinal fluid (CSF) analysis may be unreliable. The purpose of this study was to characterize the prevalence of HAVM, risk factors, and interventions in the neurocritical population admitted in the ICU. Methods This was a retrospective single-center analysis of all adult neurocritical patients admitted to an ICU during a three-year period. Results A total of 218 neurocritical patients were included. The prevalence of HAVM was 13% and it was found to be associated with mortality. When suspected, it was not possible to exclude HAVM in 30% of the patients. HAVM was significantly associated with surgery, surgical reintervention, and brain devices. Sustained fever was the most frequent clinical sign, and it was significantly associated with unexcluded HAVM. CSF cell count was significantly higher in HAVM, though without microbiological isolation in most of the cases. Conclusion Brain damage, interventions, and devices may significantly alter cerebral homeostasis. Sustained fever is very frequent and may be attributed to several conditions. CSF cell count is useful for the diagnosis of HAVM. HAVM is a clinical challenge in the management of neurocritical patients with important therapeutic and prognostic implications.
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Affiliation(s)
| | - Laura Costa
- Intensive Care Medicine, Hospital de Braga, Braga, PRT
| | - José Martins
- Intensive Care Medicine, Hospital de Braga, Braga, PRT
| | - Marina Costa
- Intensive Care Medicine, Hospital de Braga, Braga, PRT
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Tucker M, Ma G, Ross W, Buckland DM, Codd PJ. Creation of an Automated Fluorescence Guided Tumor Ablation System. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2021; 9:4300109. [PMID: 34765325 PMCID: PMC8577571 DOI: 10.1109/jtehm.2021.3097210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/05/2021] [Accepted: 06/24/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Create a device that improves the identification and extent of resection at the interface between healthy and tumor tissue; ultimately, using this device would improve surgical outcomes for patients and increase survival. METHODS We have created a contactless tumor removal system that utilizes endogenous fluorescence feedback to inform a laser ablation system to execute autonomous removal of phantom tumor tissue. RESULTS This completely non-contact surgical system is capable of resecting the tumor boundary of a tissue phantom with an average root mean square error (RMSE) of approximately 1.55 mm and an average max error of approximately 2.15 mm. There is no difference in the performance of the system when changing the size of the internal tumor from 7.5-12.5 mm in diameter. DISCUSSION Future research steps include creating a more intelligent spectral search strategy to increase the density of points around the resection boundary, and to develop a more sophisticated classifier to predict pathologic diagnosis and tissue subtypes located regionally around the tumor boundaries. We envision this device being used to resect the boundaries of tumors identified by exogenously delivered tumor-labeling fluorophores, such as fluorescein or 5-ALA, in addition to approaches relying on autofluorescence of endogenous fluorophores.
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Affiliation(s)
- Matthew Tucker
- Department of Mechanical Engineering and Materials ScienceDuke University Durham NC 27708 USA
| | - Guangshen Ma
- Department of Mechanical Engineering and Materials ScienceDuke University Durham NC 27708 USA
| | - Weston Ross
- Department of NeurosurgeryDuke University Durham NC 27708 USA
| | - Daniel M Buckland
- Department of Mechanical Engineering and Materials ScienceDuke University Durham NC 27708 USA.,Division of Emergency MedicineDuke University Durham NC 27708 USA
| | - Patrick J Codd
- Department of Mechanical Engineering and Materials ScienceDuke University Durham NC 27708 USA.,Division of Emergency MedicineDuke University Durham NC 27708 USA
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Discordance to ASHP Therapeutic Guidelines Increases the Risk of Surgical Site Infection. Pharmaceuticals (Basel) 2021; 14:ph14111088. [PMID: 34832870 PMCID: PMC8625138 DOI: 10.3390/ph14111088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022] Open
Abstract
Clean surgery without contamination does not require prophylactic antibiotics, but there are high-risk surgical procedures that may cause infection and/or involve vital organs such as the heart, brain, and lungs, and these indeed require the use of antibiotics. This study aimed to determine the quantity of antibiotic use based on the defined daily dose (DDD) per 100 bed days and the quality of antibiotic use based on the percentage of concordance with The American Society of Health-System Pharmacists (ASHP) therapeutic guidelines (i.e., route of administration, time of administration, selection, dose, and duration). This includes the profiles of surgical site infection (SSI) in surgical patients from January through June 2019. The study subjects were 487 surgical patients from two hospitals who met the inclusion criteria. There were 322 patients out of 487 patients who had a clean surgical procedure. Ceftriaxone (J01DD04) was the most used antibiotic, with a total DDD/100 bed days value in hospitals A and B, respectively: pre-surgery: 14.71, 77.65, during surgery: 22.57, 87.31, and postsurgery: 38.34, 93.65. In addition, 35% of antibiotics were given more than 120 min before incision. The lowest concordance to ASHP therapeutic guideline in hospital A (17.6%) and B (1.9%) was antibiotic selection. Two patients experienced SSI with bacterial growths of Proteus spp., Staphylococcus aureus, Staphylococcus epidermidis, and Escherichia coli. The usage of prophylactic antibiotics for surgical procedures was high and varied between hospitals. Hospital B had significantly lower concordance to antibiotic therapeutic guidelines, resulting to a higher infection rate, compared with hospital A. ASHP adherence components were then further investigated, after which antibiotic dosing interval and injection time was found to be a significant predictor for positive bacterial growth based on logit–logistic regression. Further interventions and strategies to implement antibiotic stewardship is needed to improve antibiotic prescriptions and their use.
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Affiliation(s)
- Tamer Albataineh
- Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA
| | - Sugoto Mukherjee
- Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA
| | - Joseph H Donahue
- Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA
| | - Sohil H Patel
- Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA.
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Salle H, Deluche E, Couvé-Deacon E, Beaujeux AC, Pallud J, Roux A, Dagain A, de Barros A, Voirin J, Seizeur R, Belmabrouk H, Lemnos L, Emery E, Fotso MJ, Engelhardt J, Jecko V, Zemmoura I, Le Van T, Berhouma M, Cebula H, Peyre M, Preux PM, Caire F. Surgical Site Infections after glioblastoma surgery: results of a multicentric retrospective study. Infection 2020; 49:267-275. [PMID: 33034890 DOI: 10.1007/s15010-020-01534-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The effects of surgical site infections (SSI) after glioblastoma surgery on patient outcomes are understudied. The aim of this retrospective multicenter study was to evaluate the impact of SSI on the survival of glioblastoma patients. METHODS Data from SSI cases after glioblastoma surgeries between 2009 and 2016 were collected from 14 French neurosurgical centers. Collected data included patient demographics, previous medical history, risk factors, details of the surgical procedure, radiotherapy/chemotherapy, infection characteristics, and infection management. Similar data were collected from gender- and age-paired control individuals. RESULTS We used the medical records of 77 SSI patients and 58 control individuals. 13 were excluded. Our analyses included data from 64 SSI cases and 58 non-infected glioblastoma patients. Infections occurred after surgery for primary tumors in 38 cases (group I) and after surgery for a recurrent tumor in 26 cases (group II). Median survival was 381, 633, and 547 days in patients of group I, group II, and the control group, respectively. Patients in group I had significantly shorter survival compared to the other two groups (p < 0.05). The one-year survival rate of patients who developed infections after surgery for primary tumors was 50%. Additionally, we found that SSIs led to postoperative treatment discontinuation in 30% of the patients. DISCUSSION Our findings highlighted the severity of SSIs after glioblastoma surgery, as they significantly affect patient survival. The establishment of preventive measures, as well as guidelines for the management of SSIs, is of high clinical importance.
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Affiliation(s)
- Henri Salle
- Neurochirurgie, CHU de Limoges, Limoges, France. .,CAPTuR, EA 3842, Université de Limoges, Limoges, France.
| | | | | | | | - Johan Pallud
- Neurochirurgie, GHU Paris - Hôpital Sainte-Anne, Paris, France.,IMA-BRAIN, UMR1266, Inserm, Paris, France
| | - Alexandre Roux
- Neurochirurgie, GHU Paris - Hôpital Sainte-Anne, Paris, France.,IMA-BRAIN, UMR1266, Inserm, Paris, France
| | - Arnaud Dagain
- Neurochirurgie, BCRM Toulon, HIA Sainte-Anne, Toulon, France
| | - Amaury de Barros
- Neurochirurgie, CHU de Toulouse, Hopital Pierre-Paul Riquet, Toulouse, France
| | - Jimmy Voirin
- Neurochirurgie, Hôpitaux Civils de Colmar, Colmar, France.,Neurochirurgie, CHU de Strasbourg, Strasbourg, France
| | - Romuald Seizeur
- Neurochirurgie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France.,Université de BREST, LaTIM INSERM UMR 1101, Brest, France
| | - Houda Belmabrouk
- Neurochirurgie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France
| | | | - Evelyne Emery
- Neurochirurgie, CHU Caen Normandie, Caen, France.,Université CAEN Normandie, Inserm U 12 37, Cycéron, Caen, France
| | | | | | - Vincent Jecko
- Neurochirurgie, CHU de Bordeaux, Bordeaux, France.,INCIA, UMR 5287, Université de Bordeaux, CNRS, Bordeaux, France
| | - Ilyess Zemmoura
- Neurochirurgie, CHU de Tours, Tours, France.,iBrain, UMR 1253, Université de Tours, Inserm, Tours, France
| | | | - Moncef Berhouma
- Neurochirurgie, CHU de Lyon, Hôpital Neurologique Pierre Wertheimer, Lyon, France.,Creatis Laboratory, , CNRS UMR 5220, INSERM U1206, Université Lyon 1/INSA, Lyon, France
| | - Hélène Cebula
- Neurochirurgie, CHU de Strasbourg, Strasbourg, France
| | - Matthieu Peyre
- Neurochirurgie, APHP, Groupe Hospitalier Pitié Salpêtrière, Paris, France.,Genetics and Development of Brain Tumors - CRICM INSERM U1127 CNRS UMR 7225, Paris, France
| | - Pierre-Marie Preux
- Centre d'Epidémiologie, CHU de Limoges, de Biostatistiques Et de Méthodologie de La Recherche CEBIMER, Limoges, France
| | - François Caire
- Neurochirurgie, CHU de Limoges, Limoges, France.,XLIM, UMR 7252, Université de Limoges, CNRS, Limoges, France
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37
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Long-term Effect of Cranioplasty on Overlying Scalp Atrophy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3031. [PMID: 32983786 PMCID: PMC7489738 DOI: 10.1097/gox.0000000000003031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 11/26/2022]
Abstract
Scalp thinning over a cranioplasty can lead to complex wound problems, such as extrusion and infection. However, the details of this process remain unknown. The aim of this study was to describe long-term soft-tissue changes over various cranioplasty materials and to examine risk factors associated with accelerated scalp thinning.
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38
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Predicting short-term outcomes following supratentorial tumor surgery. Clin Neurol Neurosurg 2020; 196:106016. [DOI: 10.1016/j.clineuro.2020.106016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 11/21/2022]
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39
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Jiménez-Martínez E, Cuervo G, Carratalà J, Hornero A, Ciercoles P, Gabarrós A, Cabellos C, Pelegrin I, Dominguez Luzón MA, García-Somoza D, Càmara J, Tebé C, Adamuz J, Pujol M. A Care Bundle Intervention to Prevent Surgical Site Infections after a Craniotomy. Clin Infect Dis 2020; 73:e3921-e3928. [PMID: 32594119 DOI: 10.1093/cid/ciaa884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/22/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Although surgical site infections after a craniotomy (SSI-CRAN) are a serious problem involving significant morbidity and costs, information on their prevention is scarce. We aimed to assess whether the implementation of a care bundle was effective in preventing SSI-CRANs. METHODS A historical control study was used to evaluate the care bundle, which included a preoperative shower with 4% chlorhexidine soap, appropriate hair removal, adequate preoperative systemic antibiotic prophylaxis, the administration of 1 g of vancomycin powder into the subgaleal space before closing, and a post-operative dressing of the incisional surgical wound with a sterile absorbent cover. Patients were divided into 2 groups: pre-intervention (January 2013 to December 2015) and intervention (from January 2016 to December 2017). The primary study endpoint was the incidence of SSI-CRANs within a year post-surgery. Propensity score matching was performed and differences between the two study periods were assessed using Cox regression models. RESULTS A total of 595 and 422 patients were included in the pre-intervention and intervention periods, respectively. The incidence of SSI-CRANs was lower in the intervention period (15.3% vs. 3.5%; p < 0.001). Using a propensity score model, 421 pairs of patients were matched. The care bundle intervention was independently associated with a reduced incidence of SSI-CRANs (AOR: 0.23, 95% CI: 0.13-0.40; p < 0.001). CONCLUSION The care bundle intervention was effective in reducing SSI-CRAN rates. The implementation of this multimodal preventive strategy should be considered in centers with high SSI-CRAN incidences.
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Affiliation(s)
- Emilio Jiménez-Martínez
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Guillermo Cuervo
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto Carlos III, Madrid, Spain
| | - Jordi Carratalà
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto Carlos III, Madrid, Spain
| | - Ana Hornero
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Pilar Ciercoles
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Andres Gabarrós
- Neurosurgery Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Carmen Cabellos
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto Carlos III, Madrid, Spain
| | - Ivan Pelegrin
- Infectious Diseases Department, Hospital Parc Taulí, Fundació Institut d'Investigació i Innovació Parc Taulí (I3PT), Sabadell, Spain
| | - Maria Angeles Dominguez Luzón
- Microbiology Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto Carlos III, Madrid, Spain
| | - Dolores García-Somoza
- Microbiology Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Jordi Càmara
- Microbiology Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,Nursing Information Systems Department Support, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Biostatistics Unit, IDIBELL, L'Hospitalet de Llobregat, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto Carlos III, Madrid, Spain.,Research Network for Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
| | - Cristian Tebé
- Biostatistics Unit, IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Jordi Adamuz
- Nursing Information Systems Department Support, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Miquel Pujol
- Infectious Diseases Department, Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto Carlos III, Madrid, Spain
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Winter E, Haldar D, Glauser G, Caplan IF, Shultz K, McClintock SD, Chen HCI, Yoon JW, Malhotra NR. The LACE+ Index as a Predictor of 90-Day Supratentorial Tumor Surgery Outcomes. Neurosurgery 2020; 87:1181-1190. [DOI: 10.1093/neuros/nyaa225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/28/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The LACE+ (Length of stay, Acuity of admission, Charlson Comorbidity Index [CCI] score, and Emergency department [ED] visits in the past 6 mo) index risk-prediction tool has never been successfully tested in a neurosurgery population.
OBJECTIVE
To assess the ability of LACE+ to predict adverse outcomes after supratentorial brain tumor surgery.
METHODS
LACE+ scores were retrospectively calculated for all patients (n = 624) who underwent surgery for supratentorial tumors at the University of Pennsylvania Health System (2017-2019). Confounding variables were controlled with coarsened exact matching. The frequency of unplanned hospital readmission, ED visits, and death was compared for patients with different LACE+ score quartiles (Q1, Q2, Q3, and Q4).
RESULTS
A total of 134 patients were matched between Q1 and Q4; 152 patients were matched between Q2 and Q4; and 192 patients were matched between Q3 and Q4. Patients with higher LACE+ scores were significantly more likely to be readmitted within 90 d (90D) of discharge for Q1 vs Q4 (21.88% vs 46.88%, P = .005) and Q2 vs Q4 (27.03% vs 55.41%, P = .001). Patients with larger LACE+ scores also had significantly increased risk of 90D ED visits for Q1 vs Q4 (13.33% vs 30.00%, P = .027) and Q2 vs Q4 (22.54% vs 39.44%, P = .039). LACE+ score also correlated with death within 90D of surgery for Q2 vs Q4 (2.63% vs 15.79%, P = .003) and with death at any point after surgery/during follow-up for Q1 vs Q4 (7.46% vs 28.36%, P = .002), Q2 vs Q4 (15.79% vs 31.58%, P = .011), and Q3 vs Q4 (18.75% vs 31.25%, P = .047).
CONCLUSION
LACE+ may be suitable for characterizing risk of certain perioperative events in a patient population undergoing supratentorial brain tumor resection.
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Affiliation(s)
- Eric Winter
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Debanjan Haldar
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory Glauser
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ian F Caplan
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kaitlyn Shultz
- McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia, Pennsylvania
- The West Chester Statistical Institute, Department of Mathematics, West Chester University, West Chester, Pennsylvania
| | - Scott D McClintock
- The West Chester Statistical Institute, Department of Mathematics, West Chester University, West Chester, Pennsylvania
| | - Han-Chiao Isaac Chen
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neil R Malhotra
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia, Pennsylvania
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Fiani B, Cathel A, Sarhadi KJ, Cohen J, Siddiqi J. Neurosurgical Post-Operative Wound Infections: A retrospective study on surgical site infections for quality improvement. Int Wound J 2020; 17:1039-1046. [PMID: 32315121 DOI: 10.1111/iwj.13367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 03/21/2020] [Accepted: 03/26/2020] [Indexed: 11/30/2022] Open
Abstract
Despite efforts to maintain a meticulous aseptic environment, wound infection is one of the most common complications following surgery and may be related to dehiscence, haemorrhage, infection, and/or poor surgical technique. With the appearance of new wound closure techniques and suture materials, we felt compelled to perform a retrospective study on our institution's neurosurgical population to determine how our institution compared to others in terms of incidence of surgical site infection (SSI). A retrospective analysis was performed at our single institution for all patients that had cranial or spine surgery by a neurosurgeon for the past 15 years. The data were extracted via Crimson Continuum of Care software program and analysed using χ2 and relative risk. The data retrieval software program collected a total of 1184 cranial and spinal surgeries. Of these 1184 cases, 12 resulted in post-operative wound infections. Using these collected values, we compared the results with published values in the literature. Prior studies have shown that up to 33% of surgical cases have post-operative infections. Using this reported value in comparison with our data, χ2 testing equals 547.893 with 1 df, P = .0001 (confidence interval = 0.05), which demonstrated statistical significance when compared with surgical literature. The results from this retrospective analysis demonstrated that the rate of neurosurgical post-operative SSI falls within the range consistent with the literature, which has shown rates of infection from <1% up to 15% depending on the type of surgery, surgical technique, and patient characteristics. SSIs can be an unfortunate and costly post-operative complication. Risks factors in the past have been studied, but introspection by each institution is an important metric to ensure accountability and provide optimal patient care in comparison with established data and guidelines. No deviation from current techniques is deemed necessary at our institution based on the results.
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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, USA
| | - Alessandra Cathel
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, USA
| | - Kasra J Sarhadi
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Jordan Cohen
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Javed Siddiqi
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, USA
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Hair-sparing technique using absorbable intradermal barbed suture versus traditional closure methods in supratentorial craniotomies for tumor. Acta Neurochir (Wien) 2020; 162:719-727. [PMID: 32002670 DOI: 10.1007/s00701-020-04239-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/19/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hair-sparing techniques in cranial neurosurgery have gained traction in recent years and previous studies have shown no difference in infection rates, yet limited data exists evaluating the specific closure techniques utilized during hair-sparing craniotomies. Therefore, it was the intention of this study to evaluate the rate of surgical site infections (SSIs) and perioperative complications associated with using an absorbable intradermal barbed suture for skin closure in hair-sparing supratentorial craniotomies for tumor in order to prove non-inferiority to traditional methods. METHODS A retrospective review of supratentorial craniotomies for tumor by a single surgeon from 2011 to 2017 was performed. All perioperative adverse events and wound complications, defined as a postoperative infection, wound dehiscence, or CSF leak, were compared between three different groups: (1) hair shaving craniotomies + transdermal polypropylene suture/staples for scalp closure, (2) hair-sparing craniotomies + transdermal polypropylene suture/staples for scalp closure, and (3) hair-sparing craniotomies + absorbable intradermal barbed suture for scalp closure. RESULTS Two hundred sixty-three patients underwent hair shaving + transdermal polypropylene suture/staples, 83 underwent hair sparing + transdermal polypropylene suture/staples, and 100 underwent hair sparing + absorbable intradermal barbed suture. Overall, 2.9% of patients experienced a perioperative complication and 4.3% developed a wound complication. In multivariable analysis, the use of a barbed suture for scalp closure and hair-sparing techniques was not predictive of any complication or 30-day readmission. Furthermore, the absorbable intradermal barbed suture cohort had the lowest overall rate of wound complications (4%). CONCLUSIONS Hair-sparing techniques using absorbable intradermal barbed suture for scalp closure are safe and do not result in higher rates of infection, readmission, or reoperation when compared with traditional methods.
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BİRİCİK E, GÜNEŞ Y. Nörocerrahi ve Eras (Enhanced Recovery After Surgery). ARŞIV KAYNAK TARAMA DERGISI 2020. [DOI: 10.17827/aktd.604717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dose-response association of operative time and surgical site infection in neurosurgery patients: A systematic review and meta-analysis. Am J Infect Control 2019; 47:1393-1396. [PMID: 31296347 DOI: 10.1016/j.ajic.2019.05.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND The association of operative time and surgical site infection (SSI) in neurosurgery patients is unclear. We therefore, through a systematic review and meta-analysis, sought to clarify the association. METHODS We performed a systematic search of the PubMed and Embase databases, from January 1, 1966, to December 26, 2018, for published articles. We used random effects generalized least squares regression models to combine study-specific relative risks (RR) and 95% confidence intervals (CI), and performed a sensitivity analysis by excluding 1 study at a time to assess the stability of results and potential sources of heterogeneity. We used the Egger (from plotting to test) to assess publication bias. RESULTS A total of 5 articles, with 231,915 individuals and 6,726 SSI cases, were included. The summary RR for SSI after craniotomy were 1.67 (95% CI, 1.13-2.20), with high versus low operative time, and 1.34 (95% CI, 1.15-1.53), with each 1-hour increase in operative time. On sensitivity analysis, no individual study had an excessive influence on the pooled effect. We found no evidence of publication bias by the Egger test (P = .464) and Egger's plotting. CONCLUSIONS Prolonged operative time can increase the SSI risk for neurosurgery patients. Intensive interventions should be taken to decrease operative duration.
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Hweidi IM, Barbarawi MA, Tawalbeh LI, Al-Hassan MA, Al-Ibraheem SW. Surgical site infections after craniotomy: a matched health-care cost and length of stay study. J Wound Care 2019; 27:885-890. [PMID: 30557106 DOI: 10.12968/jowc.2018.27.12.885] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To assess the extra health-care costs and length of stay resulting from surgical site infection (SSI), as well as to identify the most frequent aetiological microorganisms of SSIs among Jordanian craniotomy surgery patients. METHOD A retrospective, descriptive, correlational and nested 1:1 matched case-control design was used. A computerised list of patients, who underwent surgery between May 2009 and March 2015, was generated in the targeted hospital. A final bill for every selected patient was also determined. Patients were divided equally into two groups: patients with an SSI and patients without an SSI. RESULTS A total of 64 patients were recruited. The SSI-group had a significant higher mean health-care cost of $7,899.08 (p=0.001) and a longer stay in hospital (mean additional days: 23.17) than the non-SSI group. Furthermore, Acinetobacter baumannii and Staphylococcus aureus were determined as the most predominant causative agents of SSI, at 39.1% and 26.1% of SSI patients, respectively. CONCLUSION The results of this study can be considered as a baseline for national benchmarking to evaluate the quality of care provided to targeted patients. This study should encourage nurse administrators to adopt protocols and strategies that promote infection control measures, as well as to develop new methods of surveillance on universal precautions adherence. This may limit pathogen contamination in the surgical wound, shorten length of stay and decrease health-care costs.
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Affiliation(s)
- Issa M Hweidi
- Associate Professor; Faculty of Nursing, Adult Health Nursing Department, Jordan University of Science and Technology, Jordan
| | - Mohammed Al Barbarawi
- Professor of Neurosurgery; Faculty of Medicine, Department of Neurosurgery, Jordan University of Science and Technology, Jordan
| | - Loai Issa Tawalbeh
- Assistant Professor; Faculty of Nursing, Adult Health Nurisng Department, Al-Albayt University, Jordan
| | - Musa A Al-Hassan
- Associate Professor; Faculty of Nursing, Adult Health Nursing Department, Jordan University of Science and Technology, Jordan
| | - Saba W Al-Ibraheem
- Clinical Nurse Instructor, Faculty of Nursing, Adult Health Nursing Department, Jordan University of Science and Technology, Jordan
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Abstract
BACKGROUND Infection may complicate the outcome of cranial repair with significant additional morbidity, related to hospitalization, surgery and long antibiotic therapy, that may become even dramatic in case of multi-resistant germs and in particular in the paediatric population. Additionally, the economic costs for the health system are obvious. Moreover, surgical decisions concerning the timing of cranioplasty and choice of the material may be strongly affected by the risk of infection. Despite, management and prevention of cranioplasty infections are not systematically treated through the literature so far. METHODS We reviewed pertinent literature dealing with cranioplasty infection starting from the diagnosis to treatment options, namely conservative versus surgical ones. Our institutional bundle, specific to the paediatric population, is also presented. This approach aims to significantly reduce the risk of infection in first-line cranioplasty and redo cranioplasty after previous infection. CONCLUSIONS A thorough knowledge and understanding of risk factors may lead to surgical strategies and bundles, aiming to reduce infectious complications of cranioplasty. Finally, innovation in materials used for cranial repair should also aim to enhance the antimicrobial properties of these inert materials.
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Tunthanathip T, Sae-heng S, Oearsakul T, Sakarunchai I, Kaewborisutsakul A, Taweesomboonyat C. Machine learning applications for the prediction of surgical site infection in neurological operations. Neurosurg Focus 2019; 47:E7. [DOI: 10.3171/2019.5.focus19241] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/21/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVESurgical site infection (SSI) following a neurosurgical operation is a complication that impacts morbidity, mortality, and economics. Currently, machine learning (ML) algorithms are used for outcome prediction in various neurosurgical aspects. The implementation of ML algorithms to learn from medical data may help in obtaining prognostic information on diseases, especially SSIs. The purpose of this study was to compare the performance of various ML models for predicting surgical infection after neurosurgical operations.METHODSA retrospective cohort study was conducted on patients who had undergone neurosurgical operations at tertiary care hospitals between 2010 and 2017. Supervised ML algorithms, which included decision tree, naive Bayes with Laplace correction, k-nearest neighbors, and artificial neural networks, were trained and tested as binary classifiers (infection or no infection). To evaluate the ML models from the testing data set, their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), as well as their accuracy, receiver operating characteristic curve, and area under the receiver operating characteristic curve (AUC) were analyzed.RESULTSData were available for 1471 patients in the study period. The SSI rate was 4.6%, and the type of SSI was superficial, deep, and organ/space in 1.2%, 0.8%, and 2.6% of cases, respectively. Using the backward stepwise method, the authors determined that the significant predictors of SSI in the multivariable Cox regression analysis were postoperative CSF leakage/subgaleal collection (HR 4.24, p < 0.001) and postoperative fever (HR 1.67, p = 0.04). Compared with other ML algorithms, the naive Bayes had the highest performance with sensitivity at 63%, specificity at 87%, PPV at 29%, NPV at 96%, and AUC at 76%.CONCLUSIONSThe naive Bayes algorithm is highlighted as an accurate ML method for predicting SSI after neurosurgical operations because of its reasonable accuracy. Thus, it can be used to effectively predict SSI in individual neurosurgical patients. Therefore, close monitoring and allocation of treatment strategies can be informed by ML predictions in general practice.
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Topical Vancomycin for Surgical Prophylaxis in Pediatric Craniofacial Surgeries. J Craniofac Surg 2019; 30:2163-2167. [PMID: 31261326 DOI: 10.1097/scs.0000000000005708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Topical vancomycin has been demonstrated to be safe and effective for reducing surgical site infections (SSIs) following spine surgery in both adults and children, however, there are no studies of its efficacy in reducing SSIs in craniofacial surgery. The SSIs are one of the most common complications following craniofacial surgery. The complexity of craniofacial procedures, use of grafts and implants, long operative durations and larger surgical wounds all contribute to the heightened risk of SSIs in pediatric craniofacial cases. A retrospective review of all open and endoscopic pediatric craniofacial procedures performed between May 2014 and December 2017 at a single children's hospital was conducted to examine SSI rates between patients receiving topical vancomycin and a historical control group. The treatment group received topical vancomycin irrigation before wound closure. An ad-hoc cost analysis was performed to determine the cost-savings associated with topical vancomycin use. A total of 132 craniofacial procedures were performed during the study period, with 50 cases in the control group and 82 cases in the vancomycin group. Overall, SSI rate was 3.03%. Use of topical vancomycin irrigation led to a significant reduction in SSIs (4/50 SSI or 8.0% in control group vs 0/82 or 0% in vancomycin group, P = 0.04). No adverse events were observed with topical vancomycin use. The potential cost-savings associated with the use of topical vancomycin as SSI prophylaxis in this study was $102,152. Addition of topical vancomycin irrigation as routine surgical infection prophylaxis can be an effective and low-cost method for reducing SSI in pediatric craniofacial surgery.
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Ojdana D, Kochanowicz J, Sacha P, Sieńko A, Wieczorek P, Majewski P, Hauschild T, Mariak Z, Tryniszewska E. Infection caused by Klebsiella pneumoniae ST11 in a patient after craniectomy. Folia Microbiol (Praha) 2019; 65:205-209. [PMID: 31119589 PMCID: PMC6971140 DOI: 10.1007/s12223-019-00718-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 05/09/2019] [Indexed: 11/09/2022]
Abstract
Klebsiella pneumoniae infections have always been an important problem in public health, but today, the increasing resistance of these bacteria to antibiotics due to β-lactamases production has renewed interest in K. pneumoniae infections. The aim of the study was to present a case of a neurosurgical patient with multidrug-resistant K. pneumoniae ST11 infection after craniectomy. Four K. pneumoniae isolates from various clinical materials of the patient undergone identification and susceptibility testing with the Vitek2 system. Tests for β-lactamases production were performed according to EUCAST guidelines. Strains were analyzed for bla genes responsible for β-lactamase production (blaTEM, blaSHV, blaCTX-M, blaVIM, blaIMP, blaNDM, blaKPC, blaOXA-48) using PCR. Moreover, the genetic relatedness of these isolates was determined by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). All tested strain presented multidrug resistance. The highest susceptibility was observed for imipenem, meropenem, and ertapenem. The strain isolated from the nervous system was ESBL-positive with blaSHV-11, blaTEM-1, and blaCTX-M-15 genes. Additionally, the strain from urine was blaKPC-3-positive. Molecular typing revealed that all strains belonged to the same clone and identified two PFGE profiles. The analysis of MLST allelic profile showed that tested K. pneumoniae strains belonged to ST11. Identification of ST11 K. pneumoniae as etiological factor of infection unfavorably impacts on prognosis among neurosurgical patient after craniectomy.
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Affiliation(s)
- Dominika Ojdana
- Department of Microbiological Diagnostics and Infectious Immunology, Medical University of Bialystok, 15a Waszyngtona Street, 15-269, Bialystok, Poland.
| | - Jan Kochanowicz
- Department of Neurosurgery, University Hospital of Bialystok, 24a M. Sklodowskiej-Cure Street, 15-276, Bialystok, Poland
| | - Paweł Sacha
- Department of Microbiological Diagnostics and Infectious Immunology, Medical University of Bialystok, 15a Waszyngtona Street, 15-269, Bialystok, Poland
| | - Anna Sieńko
- Department of Microbiological Diagnostics and Infectious Immunology, Medical University of Bialystok, 15a Waszyngtona Street, 15-269, Bialystok, Poland
| | - Piotr Wieczorek
- Department of Microbiological Diagnostics and Infectious Immunology, Medical University of Bialystok, 15a Waszyngtona Street, 15-269, Bialystok, Poland
| | - Piotr Majewski
- Department of Microbiological Diagnostics and Infectious Immunology, Medical University of Bialystok, 15a Waszyngtona Street, 15-269, Bialystok, Poland
| | - Tomasz Hauschild
- Department of Microbiology, Institute of Biology, University of Bialystok, 1J Ciolkowskiego Street, 15-245, Bialystok, Poland
| | - Zenon Mariak
- Department of Neurosurgery, University Hospital of Bialystok, 24a M. Sklodowskiej-Cure Street, 15-276, Bialystok, Poland
| | - Elżbieta Tryniszewska
- Department of Microbiological Diagnostics and Infectious Immunology, Medical University of Bialystok, 15a Waszyngtona Street, 15-269, Bialystok, Poland
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Patil CG, Walker DG, Miller DM, Butte P, Morrison B, Kittle DS, Hansen SJ, Nufer KL, Byrnes-Blake KA, Yamada M, Lin LL, Pham K, Perry J, Parrish-Novak J, Ishak L, Prow T, Black K, Mamelak AN. Phase 1 Safety, Pharmacokinetics, and Fluorescence Imaging Study of Tozuleristide (BLZ-100) in Adults With Newly Diagnosed or Recurrent Gliomas. Neurosurgery 2019; 85:E641-E649. [DOI: 10.1093/neuros/nyz125] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 12/20/2018] [Indexed: 11/13/2022] Open
Abstract
AbstractBACKGROUNDFluorescence-guided surgery (FGS) can improve extent of resection in gliomas. Tozuleristide (BLZ-100), a near-infrared imaging agent composed of the peptide chlorotoxin and a near-infrared fluorophore indocyanine green, is a candidate molecule for FGS of glioma and other tumor types.OBJECTIVETo perform a phase 1 dose-escalation study to characterize the safety, pharmacokinetics, and fluorescence imaging of tozuleristide in adults with suspected glioma.METHODSPatients received a single intravenous dose of tozuleristide 3 to 29 h before surgery. Fluorescence images of tumor and cavity in Situ before and after resection and of excised tissue ex Vivo were acquired, along with safety and pharmacokinetic measures.RESULTSA total of 17 subjects received doses between 3 and 30 mg. No dose-limiting toxicity was observed, and no reported adverse events were considered related to tozuleristide. At doses of 9 mg and above, the terminal serum half-life for tozuleristide was approximately 30 min. Fluorescence signal was detected in both high- and low-grade glial tumors, with high-grade tumors generally showing greater fluorescence intensity compared to lower grade tumors. In high-grade tumors, signal intensity increased with increased dose levels of tozuleristide, regardless of the time of dosing relative to surgery.CONCLUSIONThese results support the safety of tozuleristide at doses up to 30 mg and suggest that tozuleristide imaging may be useful for FGS of gliomas.
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Affiliation(s)
| | - David G Walker
- NEWRO Foundation, Brisbane, Australia
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Australia
| | | | - Pramod Butte
- Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | | | - Kaitlin L Nufer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Australia
| | | | - Miko Yamada
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Australia
- Future Industries Institute, University of South Australia, Adelaide, Australia
| | - Lynlee L Lin
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Australia
| | - Kim Pham
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Australia
| | - Jeff Perry
- Blaze Bioscience, Inc, Seattle, Washington
| | | | | | - Tarl Prow
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Australia
- Future Industries Institute, University of South Australia, Adelaide, Australia
| | - Keith Black
- Cedars-Sinai Medical Center, Los Angeles, California
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