title: Risk factors for surgical site infections after neurosurgery: A focus on the postoperative period.
abstract: BACKGROUND
  Surgical site infection (SSI) after neurosurgery has potentially devastating consequences.
  
  
  METHODS
  A prospective cohort study was conducted over a period of 24 months in a university center. All adult patients undergoing neurosurgical procedures, with exception of open skull fractures, were included. Multivariate logistic regression analysis was used to identify independent risk factors.
  
  
  RESULTS
  We included 949 patients. Among them, 43 were diagnosed with SSI (4.5%). A significant reduction in postneurosurgical SSI from 5.8% in 2009 to 3.0% in 2010 (P = .04) was observed. During that period, an active surveillance with regular feedback was established. The most common microorganisms isolated from SSI were Staphylococcus aureus (23%), Enterobacteriaceae (21%), and Propionibacterium acnes (12%). We identified the following independent risk factors for SSI postcranial surgery: intensive care unit (ICU) length of stay ≥7 days (odds ratio [OR] = 6.1; 95% confidence interval [CI], 1.7-21.7), duration of drainage ≥3 days (OR = 3.3; 95% CI, 1.1-11), and cerebrospinal fluid leakage (OR = 5.6; 95% CI, 1.1-30). For SSIs postspinal surgery, we identified the following: ICU length of stay ≥7 days (OR = 7.2; 95% CI, 1.6-32.1), coinfection (OR = 9.9; 95% CI, 2.2-43.4), and duration of drainage ≥3 days (OR = 5.7; 95% CI, 1.5-22).
  
  
  CONCLUSIONS
  Active surveillance with regular feedback proved effective in reducing SSI rates. The postoperative period is associated with overlooked risk factors for neurosurgical SSI. Infection control measures targeting this period are therefore promising.
authors: Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UM63, CNRS 7278, IRD 198, Inserm 1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Aix-Marseille-Université, Marseille, France. Electronic address: cassirnadim@gmail.com.
authors: Nadim
authors: N
authors: Cassir
authors: Service de Neurochirurgie, CHU Nord, Marseille, France.
authors: Silvestre
authors: S
authors: De La Rosa
authors: Service de Neurochirurgie, CHU Nord, Marseille, France.
authors: Anthony
authors: A
authors: Melot
authors: Service de Neurochirurgie, CHU Nord, Marseille, France.
authors: Adamou
authors: A
authors: Touta
authors: Unité de Recherche de Santé Publique et Maladies Chroniques, Université Aix-Marseille, Marseille, France.
authors: Lucas
authors: L
authors: Troude
authors: Unité de Recherche de Santé Publique et Maladies Chroniques, Université Aix-Marseille, Marseille, France.
authors: Anderson
authors: A
authors: Loundou
authors: Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UM63, CNRS 7278, IRD 198, Inserm 1095, Institut Hospitalo-Universitaire Méditerranée-Infection, Aix-Marseille-Université, Marseille, France.
authors: Hervé
authors: H
authors: Richet
authors: Service de Neurochirurgie, CHU Nord, Marseille, France.
authors: Pierre-Hugues
authors: PH
authors: Roche
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004755:Enterobacteriaceae / Q000302:isolation & purification; D005260:Female; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery; D011182:Postoperative Care / Q000379:methods*; D011184:Postoperative Period; D011425:Propionibacterium acnes / Q000302:isolation & purification; D011446:Prospective Studies; D012307:Risk Factors; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult
keywords: Infection control; Intensive care unit; Neurosurgery; Risk factors; Surgical site infections