It has been estimated that, in spite of the use of perioperative antibiotics, 0.5-0.7% of patients undergoing a clean neurosurgical procedure develop post-operative bacterial meningitis . The incidence in clean-contaminated cases, such as transsphenoidal or surgical approaches that traverse air sinuses, ranges from around 0.4 to 2%. Although most cases probably occur as a result of direct inoculation of micro-organisms during the procedure, some cases occur from spread of infection from other nearby sites, such as a wound infection. It has been reported that the presence of a post-operative CSF leak results in a 13-fold increase in the risk of meningitis. Consequently, attempting a meticulous, water-tight dural closure should be a standard goal of any intradural procedure. It would appear that the other major independent risk factor would be early re-operation. Other potential risk factors for post-operative infection have been discussed previously. The microbiology of post-operative meningitis is consistent with the pathogenesis of infection, with staphylococcal organisms being the predominant pathogens. However, in procedures that traverse an air sinus, the most common organisms are, not surprisingly, those that customarily colonize these areas.
Was this article helpful?
The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.