Risikofaktoren postoperativer Infektionen nach neurochirurgischen Eingriffen und die Rolle der perioperativen Antibiotikaprophylaxe

Abstract

Background: Several studies disagree about the benefits of perioperative antibiotic prophylaxis. There is also disagreement about the identification of risk factors for postoperative infections where the use of perioperative antibiotic prophylaxis may play a role. This retrospective study aimed to determine the risk factors and bacteriological features of surgical site infections after neurosurgical procedures with special emphasis on perioperative antibiotic prophylaxis in preventing these infections. Methods: This study includes 918 patients undergoing a total of 1422 surgical procedures during a 26 month period. Pre-, intra- and postoperative variables such as age and risk factors such as type of craniotomy, emergency or elective surgery, duration of surgery, prolonged postoperative stay in the intensive care unit, were correlated with surgical infection rate and were discussed in the context of published literature. Results: Significant risk factors for surgery-associated postoperative infections and for general infections, e.g. pneumonia were postsurgical stay in the intensiv care unit for over 24 hours, the duration of the surgical procedure, the use of intracranial implants and emergency surgery. Age, gender, pre-existing infections and multiple surgical interventions were not risk factors. Sixty four percent (64%) of the patients received antibiotic prophylaxis, most often a first generation cephalosporin was administered. In patients receiving no antibiotics, the predominant postoperative infections were bacterial with 53% gram-negative and 37% gram-positive. Whereas patients receiving perioperative antibiotics the incidence of posoperative bacterial infections were 45% gram-positive and 43% gram-negative. Antibiotic prophylactic use significantly reduced the length of hospital stay. Sixty percent (60%) of patients with an uncomplicated postoperative hospital stay received perioperative antibiotic prophylaxis. Conclusion: The use of perioperative antibiotics significantly reduces the length of hospital stay and decreases the exposition time of operated patients to pathogenic hospital microbes. The use of perioperative antibiotics in 60% of operated patients was associated with an uncomplicated postoperative hospital stay and supports the application of perioperative antibiotics, however it is not significantly sufficient enough for completely preventing surgical side infections in neurosurgery.