53 - Postoperative Infections of the Head and Brain

Abstract

Postoperative infections following craniotomy typically are a rare occurrence, occurring at a rate of <1% in most large series. However, these infections often require prolonged antibiotic treatment and additional surgical interventions for successful eradication and may result in significant morbidity. The most common pathogens associated with postcraniotomy infections are gram-positive bacteria. Gram-negative bacteria are isolated in 5% to 8% of postoperative cranial infections and most commonly are found in deep organ space infections such as brain abscesses and meningitis. Multiple risk factors for postoperative infection have been identified, including prolonged surgery, CSF leakage, and impaired host defense. Perioperative antibiotic administration has been validated to decrease the rate of surgical site infection. Antibiotics with short half-lives, such as cefazolin, should be readministered during prolonged surgery to ensure adequate drug levels throughout the period of potential contamination. Empirical treatment of postoperative infections should include coverage for the full spectrum of potential pathogens, including resistant gram-positive organisms and nosocomial gram-negative bacilli. As the management of postcraniotomy infections continues to become increasingly complex with the emergence of highly resistant bacteria and the implantation of foreign devices, close cooperation among neurosurgeons, infectious disease specialists, and hospital infection control services is critical to achieving the best possible outcomes.