Journal of Trauma and Injury

  • 제35권4호
  • /
  • Pages.255-260
  • /
  • 2022
  • /
  • 2799-4317(pISSN)
  • /
  • 2287-1683(eISSN)
대한외상학회 (The Korean Society of Traumatology)
권호 표지
DOI QR코드

DOI QR Code

Postoperative infection after cranioplasty in traumatic brain injury: a single center experience

  • Mahnjeong, Ha (Medical Research Institute, Department of Neurosurgery, Pusan National University Hospital) ;
  • Jung Hwan, Lee (Medical Research Institute, Department of Neurosurgery, Pusan National University Hospital) ;
  • Hyuk Jin, Choi (Medical Research Institute, Department of Neurosurgery, Pusan National University Hospital) ;
  • Byung Chul, Kim (Medical Research Institute, Department of Neurosurgery, Pusan National University Hospital) ;
  • Seunghan, Yu (Medical Research Institute, Department of Neurosurgery, Pusan National University Hospital)
  • 투고 : 2022.08.16
  • 심사 : 2022.09.29
  • 발행 : 2022.12.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: To determine the incidence and risk factors of postoperative infection after cranioplasty in patients with traumatic brain injury (TBI). Methods: Data of 289 adult patients who underwent cranioplasty after TBI at a single regional trauma center between year 2018 and 2021 were reviewed retrospectively. Patient characteristics and various procedural variables, such as interval between craniectomy and cranioplasty, estimated blood loss, laterality and materials of the bone flap, and duration and classification of perioperative antibiotics usage were analyzed. Results: Postoperative infection occurred in 17 patients (5.9%). Onset time of infectious symptom ranged from 9 days to 174 days (median, 24 days) after cranioplasty. The most common cultured organism was Staphylococcus aureus (47.1%), followed by Klebsiella pneumoniae (17.6%) and Enterococcus faecalis (17.6%). Patients with postoperative infection were more likely to have diabetes (odds ratio [OR], 6.96; 95% confidence interval [CI], 1.92-25.21; P=0.003), lower body mass index (OR, 0.81; 95% CI, 0.66-0.98; P=0.029), and shorter duration of perioperative antibiotics (OR, 0.83; 95% CI, 0.71-0.98; P=0.026). Conclusions: For TBI patients with diabetes, poor nutritional status should be managed cautiously for increased risk of infection after cranioplasty. Further studies and discussions are needed to determine an appropriate antibiotics protocol in cranioplasty.

키워드

과제정보

This work was supported by a clinical research grant from Pusan National University Hospital in 2022.

참고문헌

  1. Honeybul S, Janzen C, Kruger K, Ho KM. The impact of cranioplasty on neurological function. Br J Neurosurg 2013;27:636-41. https://doi.org/10.3109/02688697.2013.817532
  2. Shahid AH, Mohanty M, Singla N, Mittal BR, Gupta SK. The effect of cranioplasty following decompressive craniectomy on cerebral blood perfusion, neurological, and cognitive outcome. J Neurosurg 2018;128:229-35. https://doi.org/10.3171/2016.10.jns16678
  3. Abode-Iyamah KO, Chiang HY, Winslow N, et al. Risk factors for surgical site infections and assessment of vancomycin powder as a preventive measure in patients undergoing firsttime cranioplasty. J Neurosurg 2018;128:1241-9. https://doi.org/10.3171/2016.12.jns161967
  4. Caruso JP, Griffin S, El Ahmadieh TY, et al. Surgical site infection after autologous cranioplasty for decompressive craniectomy in traumatic brain injury: a retrospective review of two level 1 trauma centers. J Craniofac Surg 2021;32:2728-31. https://doi.org/10.1097/SCS.0000000000007830
  5. Im SH, Jang DK, Han YM, Kim JT, Chung DS, Park YS. Long-term incidence and predicting factors of cranioplasty infection after decompressive craniectomy. J Korean Neurosurg Soc 2012;52:396-403. https://doi.org/10.3340/jkns.2012.52.4.396
  6. Lee CH, Chung YS, Lee SH, Yang HJ, Son YJ. Analysis of the factors influencing bone graft infection after cranioplasty. J Trauma Acute Care Surg 2012;73:255-60. https://doi.org/10.1097/TA.0b013e318256a150
  7. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999;27:97-132.
  8. Jeong TS, Yee GT. Prospective multicenter surveillance study of surgical site infection after intracranial procedures in Korea: a preliminary study. J Korean Neurosurg Soc 2018;61:645-52. https://doi.org/10.3340/jkns.2018.0021
  9. Skeie E, Koch AM, Harthug S, et al. A positive association between nutritional risk and the incidence of surgical site infections: a hospital-based register study. PLoS One 2018;13:e0197344.
  10. Tsantes AG, Papadopoulos DV, Lytras T, et al. Association of malnutrition with surgical site infection following spinal surgery: systematic review and meta-analysis. J Hosp Infect 2020;104:111-9.
  11. Punchak M, Chung LK, Lagman C, et al. Outcomes following polyetheretherketone (PEEK) cranioplasty: systematic review and meta-analysis. J Clin Neurosci 2017;41:30-5. https://doi.org/10.1016/j.jocn.2017.03.028
  12. Berrios-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 2017;152:784-91. https://doi.org/10.1001/jamasurg.2017.0904
  13. Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013;14:73-156. https://doi.org/10.1089/sur.2013.9999
  14. Bang JH, Cho KT, Park SY. Prophylactic effect of vancomycin on infection after cranioplasty in methicillin-resistant staphylococcus aureus carriers with traumatic brain injury. Korean J Neurotrauma 2015;11:81-6. https://doi.org/10.13004/kjnt.2015.11.2.81
  15. Paredes I, Lagares A, San-Juan R, et al. Reduction in the infection rate of cranioplasty with a tailored antibiotic prophylaxis: a nonrandomized study. Acta Neurochir (Wien) 2020;162:2857-66. https://doi.org/10.1007/s00701-020-04508-1