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Infection following a stereotactic brain biopsy: Myth or reality? Retrospective study between 2009 and 2023
Julie Dupont1, Maria Dinkova1, Caroline Tabillon1
1Réanimation Neurochirurgicale, Département D'Anesthésie-Réanimation, Hôpital De La Pitié Salpêtrière Sorbonne Université, Paris, France.
Introduction:
Stereotactic brain biopsy is a routine diagnostic tool for evaluating brain lesions. Although postoperative hemorrhage, epilepsy, and cerebral edema are recognized complications, surgical site infections are rare but still reported. Despite being classified as "clean surgery," the absence of standardized antibiotic prophylaxis remains a topic of discussion. This study aimed to quantify the incidence of postbiopsy infections (PBI) and assess their impact on patient outcomes.
Materials:
We conducted a monocentric retrospective study between 2009 et 2023 in order to determine the incidence of post-biopsy infections (PBI+) and compare them with those who were infection-free (PBI-). All patients having a stereotactic brain biopsy were included.
Results:
Over a 15-year period, 2,312 patients underwent stereotactic brain biopsy. Post-biopsy infections occurred in 11 patients (0.47%), predominantly involving Staphylococcus (36%). There were no significant differences between the PBI + and PBI - groups in terms of demographic or lesion characteristics. However, PBI + patients had longer ICU stays (21 days, p = 0.01) and longer hospital stays (11 days versus 1 day, p = 0.01). There was no significant difference in mortality.
Conclusions:
Infectious complications following stereotactic brain biopsy are rare and do not significantly affect morbidity or mortality. These findings support the continued omission of routine antibiotic prophylaxis and highlight the importance of rigorous sterile techniques and further research to identify high-risk patients.
Insights
Post-biopsy infections following stereotactic brain biopsy are rare, occurring in 0.47% of patients. While infections did not increase mortality, they were linked to longer ICU and hospital stays, underscoring the need for strict sterile techniques.
Area of Science:
- Neurosurgery
- Infectious Disease Epidemiology
- Patient Safety
Background:
- Stereotactic brain biopsy is a standard diagnostic procedure for brain lesions.
- While generally safe, potential complications include hemorrhage, epilepsy, and edema, with surgical site infections being rare.
- The necessity of routine antibiotic prophylaxis for this 'clean surgery' remains debated.
Purpose of the Study:
- To determine the incidence of post-biopsy infections (PBI) after stereotactic brain biopsy.
- To evaluate the impact of PBI on patient outcomes, including length of stay and mortality.
Main Methods:
- A monocentric retrospective study was conducted from 2009 to 2023.
- Included were all patients who underwent stereotactic brain biopsy.
- Patients were categorized into post-biopsy infection (PBI+) and infection-free (PBI-) groups for comparison.
Main Results:
- Out of 2,312 patients, 11 (0.47%) developed post-biopsy infections, with Staphylococcus being the most common pathogen (36%).
- No significant demographic or lesion characteristic differences were found between PBI+ and PBI- groups.
- PBI+ patients experienced significantly longer ICU stays (21 days) and hospital stays (11 days vs. 1 day), but mortality rates were similar.
Conclusions:
- Infectious complications from stereotactic brain biopsy are infrequent and do not significantly impact patient morbidity or mortality.
- These findings support omitting routine antibiotic prophylaxis.
- Emphasis on rigorous sterile techniques is crucial, with further research needed to identify high-risk individuals.
