Risk factors for pediatric surgical site infection following neurosurgical procedures for hydrocephalus: a retrospective single-center cohort study

BMC Anesthesiology

Mark Breibart¹  Sulpicio G. Soriano²  Miho Shibamura-Fujiogi³  Koichi Yuki³  Gregory P. Priebe⁴  Benjamin Warf⁵  Jennifer Ormsby⁶  Thomas J. Sandora⁷ 

[1] Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, 300 Longwood Avenue, 02115, Boston, MA, USA;Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, 300 Longwood Avenue, 02115, Boston, MA, USA;Department of Anaesthesia, Harvard Medical School, Boston, USA;Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, 300 Longwood Avenue, 02115, Boston, MA, USA;Department of Anaesthesia, Harvard Medical School, Boston, USA;Department of Immunology, Harvard Medical School, Boston, USA;Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, 300 Longwood Avenue, 02115, Boston, MA, USA;Department of Anaesthesia, Harvard Medical School, Boston, USA;Department of Pediatrics, Division of Infectious Diseases, Boston Children’s Hospital, Boston, USA;Department of Neurosurgery, Boston Children’s Hospital, Boston, USA;Department of Pediatrics, Division of Infectious Diseases, Boston Children’s Hospital, Boston, USA;Department of Pediatrics, Division of Infectious Diseases, Boston Children’s Hospital, Boston, USA;Department of Pediatrics, Harvard Medical School, Boston, USA;

关键词: Surgical site infections;    SSI;    Shunt;    Hydrocephalus;   

DOI  :  10.1186/s12871-021-01342-5

来源: Springer

【 摘 要 】

BackgroundInfection is a major complication following cerebral spinal fluid (CSF) diversion procedures for hydrocephalus. However, pediatric risk factors for surgical site infection (SSI) are currently not well defined. Because a SSI prevention bundle is increasingly introduced, the purpose of this study was to evaluate risk factors associated with SSIs following CSF diversion surgeries following a SSI bundle at a single quaternary care pediatric hospital.MethodsWe performed a retrospective cohort study of patients undergoing CSF diversion procedures from 2017 to 2019. SSIs were identified prospectively through continuous surveillance. We performed unadjusted logistic regression analyses and univariate analyses to determine an association between SSIs and patient demographics, comorbidities and perioperative factors to identify independent risk factors for SSI.ResultsWe identified a total of 558 CSF diversion procedures with an overall SSI rate of 3.4%. The SSI rates for shunt, external ventricular drain (EVD) placement, and endoscopic third ventriculostomy (ETV) were 4.3, 6.9 and 0%, respectively. Among 323 shunt operations, receipt of clindamycin as perioperative prophylaxis and presence of cardiac disease were significantly associated with SSI (O.R. 4.99, 95% C.I. 1.27–19.70, p = 0.02 for the former, and O.R. 7.19, 95% C.I. 1.35–38.35, p = 0.02 for the latter). No risk factors for SSI were identified among 72 EVD procedures.ConclusionWe identified receipt of clindamycin as perioperative prophylaxis and the presence of cardiac disease as risk factors for SSI in shunt procedures. Cefazolin is recommended as a standard antibiotic for perioperative prophylaxis. Knowing that unsubstantiated beta-lactam allergy label is a significant medical problem, efforts should be made to clarify beta-lactam allergy status to maximize the number of patients who can receive cefazolin for prophylaxis before shunt placement. Further research is needed to elucidate the mechanism by which cardiac disease may increase SSI risk after shunt procedures.

【 授权许可】

CC BY