Korean Journal of Nosocomial Infection Control  2009;14(2):88-97

Risk Factors for Neurosurgical Site Infections after Craniotomy: a Nationwide Prospective Multicenter Study in 2008.

Hyo Youl KIM ; Young Keun KIM ; Young UH ; Kum WHANG ; Hye Ran JEONG ; Hee Jung CHOI ; Hee Jung SON ; Hye Young JIN ; Soon Im CHOI ; Hong Bin KIM ; Eu Suk KIM ; Yoon Soo PARK ; Yong Kyun CHO ; Shin Yong PARK ; Young Goo SONG ; June Myung KIM

Keywords

Surgical site infections; Craniotomy; Risk factors; Antibiotic prophylaxis

Country

Republic of Korea

Language

Korean

Abstract

BACKGROUND: Neurosurgical site infection may have serious sequelae, especially that occurring after craniotomy. A nationwide prospective multicenter study was performed in Korea to determine the incidence and risk factors for surgical site infections (SSI) after craniotomy. Methods: We collected demographic data, clinical and operative risk factors for SSI, and information regarding the antibiotics administered for the patients who underwent craniotomy in 17 hospitals between July and December of 2008. All the data were collected using a real-time web-based reporting system. RESULTS: Of the 1,020 patients who underwent craniotomy, 31 (3%) developed SSI, including 4 with superficial incisional SSI, 2 with deep incisional SSI, and 25 with organ/space SSI. The SSI rate was predicted on the basis of the National Nosocomial Infections Surveillance (NNIS) risk index. The SSI rate of 3.1%, 3.3%, and 1.8% were ascribed NNIS scores of 0, 1, and 2, respectively. The independent risk factors for SSI identified were postoperative cerebrospinal fluid leakage (odds ratio, 12.13; 95% confidence interval, 4.54-32.42) and preoperative Glasgow coma scales score < or =8 (odds ratio, 2.35; 95% confidence interval, 1.07-5.18). Third generation cephalosporins were the most frequently (in 65.6% of the cases) used for prophylaxis. CONCLUSION: A multicenter SSI surveillance system for craniotomy was first established in Korea. The NNIS risk index was not effective in identifying the patients at risk. We required to further analyze a large number of SSI cases to correctly identify the risk factors for SSI after craniotomy.