[Aetiology of surgical infections in patients undergoing craniotomy]. / Etiología de las infecciones quirúrgicas en pacientes sometidos a craneotomía.

BACKGROUND: Postoperative infections in patients undergoing craniotomy constitute significant complications associated with increased hospital stay and patient morbidity and mortality. Knowing the aetiology of surgical infections after craniotomy may contribute to improving antibiotic prophylaxis and empirical treatment. METHOD: Information relating to surgical infections in patients undergoing craniotomy was obtained from a series of annual surveys on prevalence of infections in Spanish hospitals (EPINE) during the period 1999-2006. The study protocol collected relevant clinical information on patients with infection. Presence of infection was determined according to the Centres for Disease Control infection criteria. RESULTS: During the time period considered, 107 cases of surgical infections in patients undergoing craniotomy were diagnosed. Forty patients were women (37%) and 67 were male (63%). The mean age was 51.7 years (median 55, range 6-86 years). The duration of the intervention was over 180minutes in 49 patients (45.8%).Thirty-eight patients (35.5%) underwent emergency surgery. Seventy-eight patients (73%) received surgical prophylaxis. Thirty-eight patients (35.5%) had superficial infection of the surgical wound, 38 patients (35.5%) had deep wound infection (including bone flap) and 31 patients (29%), postoperative infections of organ or space (meningitis, subdural empyema or brain abscess). The most common aetiology corresponded to staphylococci (50%), mainly S. aureus (one third of them methicillin-resistant), Pseudomonas aeruginosa (11%), Enterobacter spp (10%) and Acinetobacter baumannii (9%). CONCLUSION: Empirical treatment of these infections should include a glycopeptide such as vancomycin and a beta-lactam with coverage against non-fermenting gram-negative bacilli.

Etiología de las infecciones quirúrgicas en pacientes sometidos a craneotomía / Aetiology of surgical infections in patients undergoing craniotomy

Introducción: Las infecciones posquirúrgicas en pacientes sometidos a craneotomía constituyen una complicación relevante que se asocia a un incremento de la estancia hospitalaria y de la morbimortalidad del paciente. El conocimiento de la etiología de las infecciones quirúrgicas tras craneotomía puede contribuir a mejorar la calidad de la profilaxis antibiótica y del tratamiento antibiótico empírico en estos pacientes. Método: Análisis de las infecciones quirúrgicas tras craneotomía en pacientes incluidos en el estudio de prevalencia de infecciones en hospitales españoles (EPINE) durante el período 1999-2006. El estudio consistía llevar a cabo una serie de estudios de prevalencia anuales realizados durante 2 semanas en más de 230 hospitales españoles. Se recogió información clínica pertinente de pacientes con infección hospitalaria. La determinación de la presencia de infección se efectuó atendiendo a los criterios de los Centers for Disease Control. Resultados: Durante el período considerado se diagnosticaron 107 casos de infecciones quirúrgicas con cultivo positivo en pacientes que habían sido intervenidos mediante craneotomía. Cuarenta pacientes eran mujeres (37%) y 67 eran varones (63%). La edad media fue de 51,7 años (mediana 55, rango 6-86 años). La duración de la intervención fue superior a 180 min en 49 pacientes (45,8%). Treinta ocho pacientes (35,5%) fueron intervenidos con carácter urgente. Setenta y ocho pacientes (73%) recibieron profilaxis quirúrgica. Treinta y ocho pacientes presentaron infección superficial de la herida quirúrgica (35,5%), 38 enfermos (35,5%) presentaron infección profunda de la herida y 31 enfermos (..) (AU)

Background: Postoperative infections in patients undergoing craniotomy constitute significant complications associated with increased hospital stay and patient morbidity and mortality. Knowing the aetiology of surgical infections after craniotomy may contribute to improving antibiotic prophylaxis and empirical treatment. Method: Information relating to surgical infections in patients undergoing craniotomy was obtained from a series of annual surveys on prevalence of infections in Spanish hospitals (EPINE) during the period 1999-2006. The study protocol collected relevant clinical information on patients with infection. Presence of infection was determined according to the Centres for Disease Control infection criteria. Results: During the time period considered, 107 cases of surgical infections in patients undergoing craniotomy were diagnosed. Forty patients were women (37%) and 67 were male (63%). The mean age was 51.7 years (median 55, range 6-86 years). The duration of the intervention was over 180 minutes in 49 patients (45.8%).Thirty-eight patients (35.5%) underwent emergency surgery. Seventy-eight patients (73%) received surgical prophylaxis (..) (AU)