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One Thousand Endoscopic Skull Base Surgical Procedures Demystifying the Infection Potential: Incidence and Description of Postoperative Meningitis and Brain Abscesses

Published online by Cambridge University Press:  02 January 2015

Yuriko Kono ,
Daniel M. Prevedello ,
Carl H. Snyderman ,
Paul A. Gardner ,
Amin B. Kassam ,
Ricardo L. Carrau  and
Karin E. Byers
Yuriko Kono*
Affiliation:
Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania
Daniel M. Prevedello
Affiliation:
Department of Neurological Surgery, Ohio State University, Columbus, Ohio
Carl H. Snyderman
Affiliation:
Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
Paul A. Gardner
Affiliation:
Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
Amin B. Kassam
Affiliation:
Neuroscience Institute, Saint lohn's Health Center, Santa Monica, California
Ricardo L. Carrau
Affiliation:
Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
Karin E. Byers*
Affiliation:
Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania
*
3601 Fifth Avenue, Suite 3A, Pittsburgh, PA 15213 ([email protected])
3601 Fifth Avenue, Suite 3A, Pittsburgh, PA 15213 ([email protected])
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Abstract

Background.

Endonasal endoscopic skull base surgery (ESBS) is perceived as having a high risk of infection because it is performed through the sinuses, which are not sterile.

Objective.

To identify the bacteriological characteristics, incidence, mortality, and risk factors for intracranial infection after ESBS.

Methods.

A retrospective analysis of the first 1,000 ESBS procedures performed at the University of Pittsburgh Medical Center from 1998 to 2008.

Results.

In 18 cases (1.8%), the patient developed meningitis. In 2 cases, the patient died within 2 months after surgery, of noninfectious causes. In 11 cases, cerebrospinal fluid (CSF) cultures had positive results. There were no predominant pathogens. Male sex (odds ratio [OR], 3.97 [95% confidence interval {CI}, 1.21-13.03]; P = .02), history of a craniotomy or endonasal surgery (OR, 4.77 [95% CI, 1.68-13.56];P = .003), surgerywith higher levels of complexity (OR, 6.60 [95% CI, 1.77-24.70];P = .005), the presence of an external ventricular drain or ventriculoperitoneal shunt at the time of surgery (OR, 6.38 [95% CI, 1.07-38.09]; P = .04), and postoperative CSF leak (OR, 12.99 [95% CI, 4.24-39.82]; P<.001) were risk factors for infection.

Conclusion.

The incidence of infection of 1.8% in ESBS is comparable to that in open craniotomy. The most important risk factor was a postoperative CSF leak. All patients recovered from their infection.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 1 , January 2011 , pp. 77 - 83
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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