title: Postoperative infection may influence survival in patients with glioblastoma: simply a myth?
abstract: BACKGROUND
  It is a prevalent myth that a postoperative infection may actually confer a survival advantage in patients with malignant glioma. This contention is based largely on anecdotal reports. Recently, a single-center study showed there was no survival advantage in those patients who had glioblastoma with postoperative infection.
  
  
  OBJECTIVE
  To examine the impact of postoperative infections on outcome in patients with glioblastoma treated at our center.
  
  
  METHODS
  This study included 197 patients with newly diagnosed primary glioblastoma treated from January 2001 to January 2008. Of the 197 patients, 10 (5.08%) had postoperative bacterial infection. The Kaplan-Meier method, log-rank test, and Breslow test were used in the univariate approach; Cox regression was used in the multivariable approach.
  
  
  RESULTS
  The median survival was 16 months (95% confidence interval [CI], 14-18 mo). The infection group had a significant advantage in the median survival: 30 months (95% CI, 21-39) vs 15 months (95% CI, 13-17) for patients without postoperative infection. This advantage was also confirmed by Cox regression; in fact, patients not developing a postoperative infection showed an adjusted hazard ratio for death of 2.3 (95% CI, 1-5.3).
  
  
  CONCLUSIONS
  The association between infection and prolonged survival is not definitive; we acknowledge the considerable difficulties in undertaking this type of study in a retrospective manner. Our results can instead stimulate further multicentric studies (to increase the number of patients) or experimental studies using genetically modified bacteria for treatment of glioblastoma.
authors: Institutes of Neuro-surgery, Catholic University School of Medicine, Rome, Italy. debonisvox@gmail.com
authors: Pasquale
authors: P
authors: De Bonis
authors: Alessio
authors: A
authors: Albanese
authors: Giorgio
authors: G
authors: Lofrese
authors: Chiara
authors: C
authors: de Waure
authors: Annunziato
authors: A
authors: Mangiola
authors: Benedetta Ludovica
authors: BL
authors: Pettorini
authors: Angelo
authors: A
authors: Pompucci
authors: Mario
authors: M
authors: Balducci
authors: Alba
authors: A
authors: Fiorentino
authors: Libero
authors: L
authors: Lauriola
authors: Carmelo
authors: C
authors: Anile
authors: Giulio
authors: G
authors: Maira
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000401:mortality*; D001932:Brain Neoplasms / Q000401:mortality* / Q000601:surgery; D005260:Female; D005910:Glioma / Q000401:mortality* / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000382:microbiology / Q000401:mortality*; D016016:Proportional Hazards Models; D012189:Retrospective Studies