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Published on: January 28, 2020
Infections in craniofacial surgery: a combined report of 567 procedures from two centers
J A Fearon1, J Yu, S P Bartlett
1Craniofacial Center, Center for Children of the Columbia Hospital at Medical City Dallas, Texas, USA.
Insights
Infectious complications after intracranial procedures for craniosynostosis occurred at 2.5%, primarily in reoperative cases. Yeast and opportunistic organisms like Candida were common, necessitating specific treatment strategies.
Area of Science:
- Craniofacial Surgery
- Infectious Disease
- Pediatric Neurosurgery
Background:
- Infectious complications are a concern following intracranial procedures.
- Understanding risk factors and common pathogens is crucial for prevention and management.
Purpose of the Study:
- To review infectious complications in intracranial procedures for craniosynostosis.
- To identify risk factors, common organisms, and effective treatment strategies.
Main Methods:
- Retrospective review of 567 intracranial procedures across two craniofacial centers.
- Analysis of 14 identified infections over a 6.5-year period.
- Evaluation of patient demographics, surgical history, organisms, and treatment outcomes.
Main Results:
- Overall infection rate was 2.5%, with 85% occurring in secondary reoperative cases.
- No infections in infants <13 months; no meningitis cases.
- Candida and Pseudomonas were most common; 28% involved yeast. Tracheostomies and scalp preparation were not risk factors.
Conclusions:
- Infection rates are higher in reoperative craniofacial surgery.
- Opportunistic organisms, particularly yeast, are significant pathogens.
- Surgical management with irrigation/drainage systems and minimal debridement is effective; further strategies to reduce opportunistic infections are recommended.
Abstract:
This retrospective review of infectious complications was undertaken at two craniofacial centers (Dallas and Philadelphia). Fourteen infections were identified over a 6.5-year period in 567 intracranial procedures primarily for craniosynostosis. There were no infections in infants under 13 months of age and no cases of meningitis. The overall infection rate was 2.5 percent, and 85 percent of infections occurred in secondary reoperative cases. Tracheostomies were not identified as a risk factor for infection. No difference was found in infection rates between patients with shaved and unshaved scalps. Candida and Pseudomonas were the two most common organisms identified, and 28 percent of our infections involved yeast. The average time to diagnose infection was 11.5 days (excluding three patients who averaged 5 months). Thirteen of the fourteen infections were treated surgically with placement of a subgaleal irrigation/drainage system. Initial bony debridement was kept to a minimum. Based on our findings, recommendations are made to further lower infection rates, particularly those caused by opportunistic organisms.
