The Investigation on Nosocomial Infection of Acinetobacter baumannii and the Clinical Analysis of Sequential Therapy of Cefoperazone/Sulbactam Sodium for Intracranial Infection.

Postoperative intracranial infection after intracranial aneurysm is relatively common in clinical setting; it is necessary to analyze the clinical risk factors of postoperative intracranial infection, to provide reliable evidence to the management of aneurysm.Patients with intracranial aneurysm admitted from January 1, 2016, to November 30, 2020, are included. We collected the patient's personal and treatment data, and analyzed the risk factors of intracranial infection by multivariate logistic regression analysis. We compared the cerebrospinal fluid (CSF) indicators and serological indicators and analyzed their correlation with intracranial infection by spearman analysis.A total of 236 patients with intracranial aneurysm were included; the incidence of postoperative intracranial infection was 12.71%. There were significant differences in the diabetes, intraoperative aneurysm rupture, intraoperative CSF leakage, duration of surgery, and estimated blood loss between infection and non-infection group. Logistic regression indicated that diabetes [odds ratio (OR) 2.053, 95% confidence interval (95% CI) 1.092∼3.385], intraoperative aneurysm rupture (OR 2.239, 95% CI 1.173∼4.312), intraoperative CSF leakage (OR 2.168, 95% CI 1.033∼3.451), duration of surgery ≥360 minutes (OR 1.926, 95% CI 1.108∼2.655), and estimated blood loss ≥125 mL (OR 2.459, 95% CI 1.854∼3.447) were the independent risk factors of postoperative intracranial infection in patients with aneurysm surgery (all P < .05). Klebsiella pneumoniae, Escherichia coli, and Staphylococcus epidermidis were the top 3 commonly seen pathogens. Spearman analyses indicated that PCT, CRP, LA, LDH were all correlated with intracranial infection (all P < .05).There are multiple factors for the postoperative intracranial infection in patients with aneurysm. Coping strategies should be formulated targeted on those risks to improve the prognosis of patients.

The objective of this study was to determine risk factors of pejorative evolution course in patients suffering from postoperative cranial infection. The data of patients who developed an intracranial infection after craniocerebral surgery in the neurosurgical intensive care unit of the First Affiliated Hospital of Nanjing Medical University in Nanjing, Jiangsu, China, from February 2018 to August 2019 were retrospectively analyzed. Logistic regression was used to analyze the factors influencing the prognosis of intracranial infection treatment. Sixty-four patients developed an infection after craniocerebral surgery, and 48 of them with negative CSF cultures received experimental anti-infectives. In 16 patients, cerebrospinal fluid culture showed pandrug-resistant pathogens, including 11 Acinetobacter baumannii (11), Klebsiella pneumoniae (3), Escherichia coli (1), and Candida glabrata (1). Nine patients received intraventricular or intrathecal injections of polymyxin B. The mean duration of infection treatment was 22.2 ± 9.9 days, and the clinical cure rate was 85.9% (55/64). Logistic multivariate regression analysis showed that inadequate CSF drainage (OR, 6.839; 95% CI, 1.130-41.383; P = 0.036) and infection with drug-resistant bacteria (OR, 24.241; 95% CI, 2.032-289.150; P = 0.012) were independent risk factors for postoperative intracranial infection. Intracranial infection with positive CSF culture and inadequate CSF drainage are factors contributing to the poor prognosis of intracranial infection. Moreover, early anti-infection treatment and adequate CSF drainage may improve patient outcomes. In particular, intraventricular or intrathecal injection of polymyxin B may be a safe and effective treatment strategy for MDR/XDR gram-negative bacilli infection.

Background: Craniocerebral operation is the main method for the treatment of traumatic brain injury. However, it is very easy to be complicated with intracranial infection after operation, which affects the surgical efficacy and patient’s prognosis. It is also the main cause of surgical failure. It may also cause patient’s death for some patients with serious diseases. It is found that the infection after craniocerebral operation is often accompanied with abnormal changes of body-related treatment, in which the changes of serological indicators are more significant. Therefore, it is helpful to provide guidance for the prevention and judgment of patient’s postoperative infection by analyzing the patient’s serological indicators. Objective: To investigate the risk factors of intracranial infection and the levels of serum procalcitonin (PCT) and endothelin-1 (ET-1) in patients after traumatic brain injury. Methods: From January 2018 to January 2021, 58 patients with intracranial infection after traumatic brain injury (infection group) were selected, and 116 patients without intracranial infection after traumatic brain injury (non-infection group) were selected. The difference of clinical data between the two groups was analyzed. Serum PCT and ET-1 levels were measured in the two groups. Results: In the infection group, admission GCS scoring &lt;8 points, operation time ≥4h, indwelling time of drainage tube ≥ 2d, preoperative ALB &lt;35g/ L, mechanical ventilation and cerebrospinal fluid leakage were 63.79%, 72.41%, 43.10%, 68.97%, 32.76% and 68.97% respectively, which were obviously higher than those in the non-infection group (P&lt;0.05). Logistic regression analysis results showed that admission GCS scoring, operation time, indwelling time of drainage tube, preoperative ALB, mechanical ventilation and cerebrospinal fluid leakage were the influencing factors of intracranial infection after traumatic brain injury (OR = 0.712,1.556,1.451,0.641,1.954 and 1.667, P&lt;0.05); serum PCT and ET-1 in the infection group were (0.83 ± 0.20) mg/L and (0.87 ± 0.23) ng/L, respectively, which were significantly higher than those in the non-infection group (P&lt;0.05); serum PCT and ET-1 in patients with different sex, age and pathogen had no significant difference (P&gt;0.05); serum PCT and ET-1 area under ROC curve were 0.828 and 0.751, respectively P&lt;0.05. Conclusion: The intracranial infection of patients with traumatic brain injury are affected by many factors including, admission GCS scoring, operation time, and so on, the levels of serum PCT and ET-1 in patients with intracranial infection are increased, which may be useful in predicting intracranial infection.

Intracranial infection is one of the most common complications of microvascular decompression (MVD). However, the risk factors for intracranial infection after MVD remain unknown. The aim of this study was to identify the risk factors for the development of post-MVD intracranial infection and to provide a basis for the prevention and control of intracranial infection following MVD. The clinical data of 154 patients with cranial nerve diseases who underwent MVD from October 2010 to August 2024 were retrospectively analyzed. The risk factors of intracranial infection were subjected to univariate and multivariate analysis. Twenty-four cases of intracranial infection occurred in 154 patients in this study, for a total infection rate of 15.6%. Univariate analysis showed that gender, duration of operation, CSF leakage, mastoid air cells breach, implants and intra-operative use of antibiotics were the risk factors related to intracranial infection after MVD (P < 0.05). Multivariate logistic regression analysis showed that a duration of operation and mastoid air cells breach were independent risk factors of intracranial infection after MVD (P < 0.05). The ROC curve analysis revealed that duration of operation, mastoid air cells breach and combined prediction exhibited area under the curve (AUC) values of 0.675 (95% CI [0.562–0.788]), 0.713 (95% CI [0.586–0.840]), 0.807 (95% CI [0.712–0.903]), respectively, for predicting intracranial infection after MVD. Duration of operation and mastoid air cells breach were independent risk factors for postoperative intracranial infection after MVD. The combination of two factors has high value in predicting the risk of intracranial infection following MVD.

BackgroundIntracranial infection after puncture of cerebral hematoma in patients with intracerebral hemorrhage is very common in the department of neurosurgery, yet the relevant risks remain unknown. We attempted to analyze the risk factors of intracranial infection after puncture of cerebral hematoma, to provide insights into the management of patients with intracerebral hemorrhage after puncture of cerebral hematoma.MethodsPatients with intracerebral hemorrhage after puncture of cerebral hematoma treated in our hospital from January 2017 to January 2020 were selected, the related characteristics of intracranial infection and no infection patients were compared. Logistic regression analyses were conducted to analyze the risk factors for intracranial infection after puncture of cerebral hematoma.ResultsA total of 925 patients with puncture of cerebral hematoma were included. The incidence of postoperative intracranial infection was 7.03%. There were significant statistical differences between the infected group and the no infection group in the American Association of Anesthesiologists (ASA) grade, length of hospital stay, consecutive operation, duration of surgery, extra-ventricular drainage (EVD) use (all p < 0.05). There was statistically significant difference in the duration of EVD between the infection and no infection groups (p = 0.002), and there was no significant difference in the frequency of EVD insertion between the two groups (p = 0.094). The length of hospital stay≥10 days (OR1.832, 1.062–3.158), consecutive operation (OR2.158, 1.358–3.430), duration of surgery≥4 h (OR1.581, 1.031–2.425), EVD use (OR1.694, 1.074–2.670), and duration of EVD ≥ 7 days (OR2.699, 1.689–4.311) were the risk factors of intracranial infection in patients with intracerebral hemorrhage after puncture of cerebral hematoma (all p < 0.05).ConclusionClinical medical workers should take corresponding preventive measures against the different risk factors for prevention of intracranial infection in patient with puncture of cerebral hematoma.

ObjectiveTo analyse the risk factors for intracranial infection after neuroendoscopic transnasal pituitary adenoma resection (NTPAR) to provide a reference for the prevention and treatment of postoperative intracranial infection.MethodsThe clinical data of 387 patients who underwent NTPAR in the Department of Neurosurgery of the First People’s Hospital of Yichang from March 2013 to March 2021 were retrospectively analysed. The patients were divided into an infected group and a noninfected group according to the occurrence of intracranial infection. The detailed clinical data of the two groups were collected. Univariate and multivariate logistic regression was used to analyse the risk factors for intracranial infection after NTPAR.ResultsAmong the 387 surgical patients, 32 patients (8.27%) were in the intracranially infected group and 355 patients (91.73%) were in the noninfected group. The results of the univariate analysis suggested that age > 45 years, tumour size > 1 cm, operation time > 240 min, blood loss > 400 ml, Kelly Grade of cerebrospinal fluid (CSF) leakage > Grade 2, postoperative CSF leakage, lumbar cistern drainage and blood transfusion were the influencing factors for postoperative intracranial infection, while the results of multivariate logistic regression analysis implied that intraoperative CSF leakage (Kelly Grade > 2) and postoperative CSF leakage were independent influencing factors for intracranial infection after NTPAR, and perioperative use of antibiotics was an independent protective factor for postoperative intracranial infection.ConclusionsThere are a variety of risk factors for intracranial infection after NTPAR, which indicates that it is necessary to develop different repair strategies for CSF leakage according to the Kelly Grade, timely treatment of postoperative CSF leakage and perioperative use of antibiotics. These measures have been shown to effectively reduce the probability of intracranial infection after NTPAR.

ObjectiveTo investigate the relationship between suprasellar extension (SSE) and intracranial infection after endoscopic endonasal transsphenoidal approach (EETA) for pituitary adenoma resection.MethodsWe retrospectively analyzed 94 patients with suprasellar extended pituitary adenoma admitted to the Department of Neurosurgery of the Affiliated Hospital of Guilin Medical College from January 2018 to December 2021. We measured the preoperative magnetic resonance sagittal SSE and collected clinical data and divided the patients into groups according to the presence of postoperative intracranial infection. The critical value for the SSE was calculated by using a working characteristic curve for the subjects. The risk factors for intracranial infection after EETA resection of pituitary adenomas were analyzed by multivariate regression analysis.ResultsAmong the 94 patients, 12 cases (12.8%) were placed in the infection group and 82 cases (87.2%) in the non-infection group. The cut-off value for the SSE in the sagittal position was 15.6 mm, the sensitivity was 75%, the specificity was 87.8%, and the area under the curve (AUC) was 0.801. The coronary cut-off value for the SSE was 15.8 mm, the sensitivity was 66.7%, the specificity was 79.3%, and the AUC was 0.787. The SSE values in the sagittal and coronal positions were correlated with postoperative intracranial infection (P < 0.05). After univariate analysis, those with significant differences were included in the multivariate regression analysis. It was concluded that the extension distance of the tumor above the sella in the sagittal position was ≥ 15.6 mm, the tumor texture was hard, and the postoperative cerebrospinal fluid leakage were the independent risk factors for intracranial infection after EETA resection of suprasellar extended pituitary tumors (P < 0.05).ConclusionsThe value of SSE on sagittal MRI can predict intracranial infection in patients with suprasellar extended pituitary adenoma after endoscopic endonasal transsphenoidal resection. This finding recommends neurosurgeons pay more attention to the imaging characteristics of pituitary adenomas and select appropriate treatment plans in combination with the intraoperative conditions to reduce the incidence of intracranial infection.

The aim of this study was to study the risk factors of intracranial infection after traumatic craniotomy in multiple trauma to provide references for clinical prevention and control of intracranial infection. A total of 34 multiple trauma patients treated with craniotomy and complicated with intracranial infection from February 2012 to December 2016 in the department of neurosurgery of our hospital were selected as infection group, and 60 multiple trauma patients who had not been infected after craniotomy during the same period were selected as control group. Related risk factors were screened by univariate analysis at first and analyzed by Logistic regression. Of the 34 patients in the infection group, 13 cases were cured, 21 cases improved, whereas in the control group, 15 cases were cured and 45 cases improved. There was no significant difference in prognosis between the 2 groups (P > 0.05). Univariate analysis showed that surgical approach, surgical duration, postoperative cerebrospinal fluid leakage, and external drainage were important factors for intracranial infection after craniotomy (P < 0.05). Further Logistic regression analysis showed that postoperative external drainage, cerebrospinal fluid leakage, surgical time, and posterior fossa approaches were independent risk factors for intracranial infection after craniotomy. High attention should be paid to the risk factors of intracranial infection after craniotomy such as postoperative cerebrospinal fluid leakage, external drainage, surgical duration and approach, and taking effective preventive measures to reduce the incidence of intracranial infection after craniotomy in patients with multiple traumatic injuries.

Objective To investigate the risk factors of intracranial infection in patients with invasive intracranial pressure monitoring. Methods In this study, 368 cases with craniocerebral injury (268 males and 100 females) were selected in Jiaxing Second Hospital from February 2016 to June 2017. They were hospitalized and were in accordance with the standard of diagnosis. The patients were divided into infection group (50 cases) and non-infection group (318 cases) according to whether the patient had intracranial infection or not. The differences in preoperative Glasgow Coma Scale, preoperative antibiotic use, invasive procedures, invasive time, ruptured intracranial aneurysms, combined skull base fractures and platelet counts were compared between the two groups. Logistic regression analysis was used to analyze the risk factors of intracranial infection by invasive intracranial pressure monitoring. Results Single factor analysis showed that comparing two groups, the differences were significant in the probe placement mode, probe indwelling time, cerebrospinal fluid leakage, extraventricular drainage, intracranial ruptured aneurysm, combined with skull base fracture, operation time and platelet count (χ2=5.530, 4.691, 11.387, 4.784, 19.473, 9.362, 17.173, 9.744, P all<0.05) . Logistic regression analysis showed that the operation time ≥ 4 h (OR=4.942, 95%CI: 1.657-4.169) , cerebrospinal fluid leakage (OR=2.976, 95%CI: 1.338-6.012) , intracranial ruptured aneurysm (OR=9.306, 95%CI: 6.142-11.932) , probe placement was performed under subdural drill or craniotomy (OR=0.085, 95%CI: 0.013-0.804) , extra ventricular drainage (OR=8.159, 95%CI: 2.102-29.734) were independent risk factors for intracranial infection by invasive intracranial pressure monitoring (P<0.05) . Conclusions It is suggested that the clinical indicators can be used to reduce the complications of invasive intracranial pressure monitoring by controlling the relevant indicators of invasive operation. Key words: Intracranial pressure; Infection; Risk factors

Risk Factors for Intracranial Infection in Surgical Patients with Suprasellar Craniopharyngiomas by an Expanded Endoscopic Endonasal Approach: A Single-Center Initial Experience.

Intracranial infection, as a complication of craniotomy, has a relatively low incidence rate. However, completely preventing post-craniotomy intracranial infections (PCI) remains challenging. Although established protocols exist for managing PCI, patients with severe infections still face risks of disability and mortality. This study aims to analyze high-risk factors for intracranial infections after craniotomy and explore preventive and management strategies to provide guidance for clinical practice. The authors retrospectively analyzed clinical data from 742 patients who underwent craniotomy between July 2018 and December 2024. 31 cases of PCI were included in the case group, while 711 non-infected cases served as the control group. Demographic, clinical, laboratory, and surgical data were compared between the two groups. Univariate analysis and binary logistic regression models were used to identify risk factors for intracranial infection. In this study, the incidence of PCI in the authors' neurosurgery department was 4.18%. The infection group showed significantly higher rates of prolonged hospitalization, cerebrospinal fluid (CSF) leakage, intensive care unit (ICU) admission, elevated C-reactive protein (CRP) levels, American Society of Anesthesiology (ASA) class > 3, infratentorial surgery, and ventricular drainage placement compared to the control group. Conversely, the infection group had significantly lower Glasgow Coma Scale (GCS) scores (all p < 0.05). Univariate analysis identified emergency surgery, reoperation, posterior fossa surgery, ventricular drainage placement, ASA > 3, postoperative CSF leakage, ICU admission, stress ulcers, hemoglobin ≤ 110.82g/L, hyperlipidemia, and high-density lipoprotein (HDL) ≤ 0.89 mmol/L as significant risk factors (p < 0.05). Binary logistic regression revealed CSF leakage (OR: 19.28, 95% CI: 5.24-70.90) and ventricular drainage surgery (OR: 8.18, 95% CI: 2.53-26.39) as independent risk factors. Postoperative CSF leakage and ventricular drainage are critical risk factors for intracranial infection after craniotomy. Preventive measures, including meticulous watertight dural closure, preservation of the temporal muscle fascia during suturing, subcutaneous tunneling of ventricular drains, and improved postoperative drain management, may decrease infection rates. Timely CSF drainage and targeted antimicrobial therapy are essential for managing established infections.

BackgroundIntracranial infection, serving as a severe postoperative infection after craniotomy, poses significant problems for patients' outcomes.ObjectiveTo explore risk factors for intracranial infection after craniotomy.MethodsA total of 2,174 patients who underwent craniotomy from 1 May 2018 to 30 June 2019 were retrospectively studied. Finally, 196 patients with intracranial infections were classified as case group, and 392 patients randomly selected from patients without intracranial infection were classified as control group. Demographic, clinical, laboratory, microbiological, and antimicrobial data were systemically recorded. The characteristics, pre‐ and postoperative variables, and other variables were evaluated as risk factors for intracranial infection by univariate analysis and binary logistic regression model.ResultsThere was no significant difference in terms of demographics between two groups, except for gender, hypertension, length of stay (LOS), intraoperative blood loss, tumor, and trauma surgery. The independent risk factors were male, age ≤45, hypertension, tumor surgery, surgery in autumn (compared with spring), surgical duration ≥4 hr, intraoperative blood loss ≥400 ml, and postoperative oral infection, coma, and serum RBC > normal value. Trauma surgery (p < .001, OR = 0.05, 95% CI: 0.017–0.144) was an independent protective factor (p < .05, OR < 1) for intracranial infection. All 196 patients in the case group submitted specimens for cerebrospinal fluid (CSF) cultures, and 70 (35.71%) patients had positive results. Gram‐positive pathogens predominated (59 cases, 84.28%). Staphylococcus were the most common causative pathogens, and fully resistant to aztreonam, cefazolin, and benzylpenicillin, but not resistant to linezolid and minocycline.ConclusionIdentifying the risk factors, pathogens, and pathogens' antibiotic resistance for intracranial infection after craniotomy plays an important role in the prognosis of patients.

Risk factors and cerebrospinal fluid indexes analysis of intracranial infection by Acinetobacter baumannii after neurosurgery

Risk Factors for Intracranial Infection Secondary to Penetrating Craniocerebral Gunshot Wounds in Civilian Practice

Intracranial infection is a severe complication following intracranial aneurysm surgery, associated with higher rates of morbidity and mortality. This study aimed to develop and validate a nomogram to predict the risk for intracranial infection after intracranial aneurysm surgery. This nomogram was designed to assist clinicians in identifying high-risk patients and implementing targeted preventive measures, ultimately improving postoperative outcomes. This retrospective cohort study included patients who underwent intracranial aneurysm surgery at a single center. Data regarding potential predictors, including clinical characteristics, surgical details, and laboratory test results, were collected. Independent risk factors for intracranial infection were identified using univariate and multivariate logistic regression analyses. A nomogram was constructed on the basis of these predictors. Nomogram performance was evaluated using the area under the receiver operating characteristic curve (AUC) for discrimination, calibration plots for predictive accuracy, and decision curve analysis (DCA) for clinical utility. Data from 612 patients who underwent intracranial aneurysm surgery were analyzed, with 428 and 184 patients in the training and validation cohorts, respectively. Multivariate logistic regression analysis identified pneumonia, external ventricular drainage, tracheotomy, procalcitonin, C-reactive protein, and albumin levels as independent risk factors for intracranial infections (p < 0.05). A nomogram, constructed on the basis of these predictors, exhibited excellent discrimination, with an AUC of 0.91 (95% confidence interval [CI] 0.88-0.93) in the training cohort and 0.89 (95% CI 0.84-0.93) in the validation cohort. DCA demonstrated that the nomogram provided a significant net clinical benefit across a range of risk thresholds, supporting its utility in clinical decision making. The nomogram developed was a robust and practical tool for predicting the risk for intracranial infection after intracranial aneurysm surgery. It demonstrated strong predictive accuracy and calibration, with potential applications in identifying high-risk patients and guiding individualized preventive strategies. However, validation using a broader and more diverse population is recommended to enhance the generalizability of the model.