Postoperative Neurosurgical Infections

In spite of numerous improvements in aseptic technique and prophylaxis, post-operative infection following craniotomy continues to be a source of substantial morbidity. Post-craniotomy infection comprises a spectrum of infectious processes, including superficial wound infections, bone flap infection, bacterial meningitis, EDA, SDE and cerebral abscess. Assessment of the true incidence of post-operative infection is difficult and comparison of rates between studies is particularly problematic. Indeed, there is no consensus as to exactly what constitutes an infection. In some studies, infection is defined by a subjective impression, while in others, objective parameters such as positive bacterial cultures are required. Furthermore, notwithstanding the lack of a precise definition for infection, incidence rates are not calculated in a standard fashion. Various studies utilize different values for the denominator, including the number of procedures, incisions, discharges, admissions and patients undergoing a procedure. Similarly, the numerator differs; some studies include multiple infections in the same patient, patients with shunt infections and even patients with systemic infections.

The incidence of infection within 30 days of craniotomy ranges from 0 to 22%, with an average rate of around 5%. Lal et al. summarized post-craniotomy infection rates from a review of the neurosurgical literature reported between 1913 and 1992 [29]. If one series that did not provide data regarding total cran-iotomies and number of infections and a second series in which the results included all types of infection (urinary tract, pneumonia, etc.) are eliminated, 18 series that included 9,336 craniotomies are left. Among these patients, there were a total of 421 post-operative infections -an infection rate of 4.5%. Interestingly, the infection rates before and after 1940 are nearly indentical: 4.4% (91 infections in 2,054 procedures) and 4.5% (330 infections in 7,284 procedures), respectively.

Numerous studies have attempted to identify potential risk factors that might increase the rate of infection. Factors that have been felt to play a significant role include age, the presence of a concomitant systemic infection, duration of operation, re-operation, the use of externalized drains, surgeon experience, use of perioperative steroids and the use of perioperative antibiotics. Indeed, intuitively, all of these factors could conceivably contribute to a higher incidence of post-operative infection. However, the ability to measure some of these variables has caused a number of these studies to be questioned. Korinek et al. recently performed a prospective evaluation of 2,944 adult patients who underwent craniotomy [30]. Univariate analysis identified the following as predictive risk factors: emergency surgery, contaminated or dirty wound classification, duration of procedure being more than 4 hours, neurosurgical procedure within 30 days and post-operative CSF leak. This analysis assumes that the predictors act in isolation and are not influenced by other factors. However, following multivariate analysis, only post-operative CSF leak and re-operation proved to be independent risk factors.

Cure Your Yeast Infection For Good

Cure Your Yeast Infection For Good

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.

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