Differences in microorganisms causing infection after cranial and spinal surgeries.

Area of Science:

• Neurosurgery
• Infectious Disease Epidemiology
• Surgical Site Infections

Background:

• Surgical site infections (SSIs) are a significant complication following neurosurgical procedures.
• Understanding pathogen differences between cranial and spinal surgeries is crucial for targeted prevention strategies.

Purpose of the Study:

• To compare pathogens causing SSIs in craniectomies/craniotomies versus open spinal surgery.
• To assess differences in SSI rates among these neurosurgical procedures.

Main Methods:

• Retrospective analysis of 19,993 postneurosurgical patient records (2007-2020).
• Statistical analysis using ANOVA with Bonferroni correction and incidence risk ratios (RRs).

Main Results:

• Overall SSI rates: 2.1% (craniotomy/craniectomy), 1.1% (laminectomy), 1.5% (fusion).
• Craniotomy/craniectomy had a higher likelihood of SSI (RR 1.8) compared to spine surgery.
• Cutibacterium acnes, CoNS, K. aerogenes, S. marcescens, E. cloacae, and C. albicans were more common in cranial SSIs.
• P. aeruginosa and E. coli were more associated with lumbar fusion SSIs.

Conclusions:

• Lumbar fusion SSIs are often linked to gastrointestinal/genitourinary flora contamination.
• Cutibacterium acnes is a key pathogen for cranial surgery SSIs.
• Recommendations include modified skin preparation for cranial surgeries and broader antibiotic prophylaxis for lumbar fusion.