Differences in microorganisms causing infection after cranial and spinal surgeries

OBJECTIVE The primary aim of this retrospective study was to assess differences in the pathogens causing surgical site infections (SSIs) following craniectomies/craniotomies and open spinal surgery. secondary rates SSI among these operative procedures. METHODS ANOVA tests with Bonferroni correction incidence risk ratios (RRs) were used identify by procedure using retrospective, de-identified records 19,993 postneurosurgical patients treated between 2007 2020. RESULTS overall infection for craniotomy/craniectomy, laminectomy, fusion 2.1%, 1.1%, 1.5%, respectively, cervical, thoracic, lumbar spine surgery 0.3%, 1.6%, 1.9%, respectively. Craniotomy/craniectomy more likely result an than (RR 1.8, 95% CI 1.4–2.2, p < 0.0001). Cutibacterium acnes 24.2, 7.3–80.0, 0.0001); coagulase-negative staphylococci (CoNS) (methicillin-susceptible CoNS: RR 2.9, 1.6–5.4, = 0.0006; methicillin-resistant 5.6, 1.4–22.3, 0.02); Klebsiella aerogenes 6.5, 1.7–25.1, 0.0003); Serratia marcescens 2.4, 1.1–7.1, 0.01); Enterobacter cloacae 3.1, 1.2–8.1, Candida albicans 3.9, 1.2–12.3, 0.02) commonly associated craniotomy/craniectomy cases or laminectomy SSIs. Pseudomonas aeruginosa SSIs craniotomy 4.4, 1.3–14.8, 0.02), whereas Escherichia coli nonsignificantly compared 4.1, 0.9–18.1, 0.06). Infections E. P. occurred primarily (p 0.0003 0.0001, respectively). CONCLUSIONS due typical gastrointestinal genitourinary gram-negative bacteria occur most surgery, particularly fusion, are be contamination bed microbial flora perianal area tract. skin head neck increases microbe interventions body sites. types suggest potential environmental sources pathogens. Based on authors’ findings, neurosurgeons should consider a two-step preparation benzoyl peroxide, addition standard antiseptic such as alcoholic chlorhexidine cranial, upper thoracic surgeries. Additionally, broader bacterial coverage, use third-generation cephalosporin, considered lumbar/lumbosacral antibiotic prophylaxis.