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Effects of Mechanical Methods Used in Peri-implantitis Treatment on Implant Surface Decontamination and Roughness

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Association between post-craniotomy Propionibacterium acnes infection and dural implants: a case-control study.

C McKerr¹, N Coetzee², O Edeghere³

¹Field Epidemiology Services, Public Health England, West Midlands, UK; Field Epidemiology Training Programme, Public Health England, London, UK.

The Journal of Hospital Infection

|July 12, 2017

Summary

A Propionibacterium acnes outbreak following craniotomies was investigated. Dural implants and improper skin disinfectant use were linked to increased infection risk, alongside poor theatre ventilation.

Keywords:

Case–control study Craniotomy Healthcare-associated infections Nosocomial Propionibacterium acnes Surgical site infection

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Area of Science:

Medical Microbiology
Infectious Disease Epidemiology
Surgical Site Infections

Background:

An outbreak of deep-seated Propionibacterium acnes infections occurred in patients post-craniotomy in a UK hospital in 2011.
This necessitated an investigation to identify the source and risk factors.

Purpose of the Study:

To describe the Propionibacterium acnes outbreak following craniotomies.
To identify the source, risk factors, and inform control measures for the infection.

Main Methods:

Case-control study involving 15 patients with P. acnes surgical site infection (SSI) and 65 controls.
Analysis of clinical records, surgical variables, and infection prevention procedures.
Environmental assessment of theatre ventilation and disinfectant use.

Main Results:

Dural implant insertion (aOR: 14.6) and use of an alcohol/Betadine/chlorhexidine disinfectant mix (aOR: 7.9) were associated with increased odds of P. acnes infection.
Theatre ventilation systems were found to deliver air exchange rates below recommended standards.

Conclusions:

A significant association exists between dural implants and P. acnes infection.
Inefficient skin disinfectant use and environmental factors, such as inadequate ventilation, likely contributed to the outbreak.
Recommendations include enhanced surveillance, use of chlorhexidine disinfectant, and improved theatre environmental controls.