title: Prevention of postoperative intracranial infection in patients with cerebrospinal fluid rhinorrhea.
abstract: BACKGROUND
  Intracranial infection is a common postoperative complication of neurosurgery. This study aimed to identify risk factors of postoperative intracranial infection in patients with cerebrospinal fluid rhinorrhea and to suggest proposals for the prevention.
  
  
  METHODS
  A total of 167 patients (113 males and 54 males, average age of 34.4 years) with cerebrospinal fluid rhinorrhea operated on by the senior author were retrospectively reviewed. The data collected included etiology, previous history, clinical manifestation, site of bone defect, operative approach, and postoperative complications. Risk factor(s) for postoperative infection were analyzed using the stepwise multiple Logistic regression.
  
  
  RESULTS
  Eighteen (10.8%) patients were infected post-operatively. The independent risk factors for infection were the site of defect (RR = 0.508, 95%CI 0.306 - 0.843, P = 0.009) and historical meningitis (RR = 0.290, 95%CI 0.094 - 0.893, P = 0.031). Patients with multiple defects and saddle floor defects had a higher infection rate. The germiculture was positive in 11 patients, and vancomycin was sensitive to all the pathogenesis. Nine infected patients needed lumbar drainage. Ten patients had hyponatremia, and hydrocephalus occurred in two patients with serious trauma.
  
  
  CONCLUSIONS
  To prevent the infection, we should pay closer attention to the high-risk patients pre-operation. During the operation, the methods those can improve wound healing, such as using blood-supply materials, reliable fixation, and eliminating dead space are all helpful. Conducting lumbar drainage and choosing effective prophylactic antibiotics in the early postoperative stage for the high-risk patients are methods of postoperative management.
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
authors.forename: Zhi-Jun
authors.initials: ZJ
authors.lastname: Yang
authors.forename: Hong-Liang
authors.initials: HL
authors.lastname: Zhong
authors.forename: Zhen-Min
authors.initials: ZM
authors.lastname: Wang
authors.forename: Fu
authors.initials: F
authors.lastname: Zhao
authors.forename: Pi-Nan
authors.initials: PN
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001927:Brain Diseases; D002559:Cerebrospinal Fluid Rhinorrhea / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D055815:Young Adult