A new retrospective study conducted at Rhode Island Hospital has revealed significant differences in the microorganisms causing surgical site infections (SSIs) following craniectomies/craniotomies and open spinal surgery. The study, which examined surgeries performed in over 19,000 patients, aimed to shed light on the pathogens associated with infections at specific surgical sites. The study was led by Leonard A. Mermel, DO, ScM, Medical Director of the Department of Epidemiology and Infection Control, at Lifespan health system in Rhode Island.
The findings of the study, published in the Journal of Neurosurgery, highlight the causative pathogens at each surgical site and type of surgery at each site. The study found that Klebsiella aerogenes, Serratia marcescens, and Enterobacter cloacae were significantly more likely to be associated with craniotomy/craniectomy SSIs compared to spine surgeries while Pseudomonas aeruginosa and Escherichia coli, were significantly more often associated with lumbosacral SSIs compared to craniotomy/craniectomy SSIs or cervicothoracic SSIs. The authors believe that the microorganisms causing infections in the lumbosacral spine likely emanate from patient’s gastrointestinal and genitourinary tract; however, some of the microorganisms causing infections after craniotomy/craniectomy such as Serratia marcescens and Enterobacter cloacae, may have environmental sources.
The implications of these findings are significant for SSI prevention. The study suggests considering intraoperative preparation of cranial, cervical, and upper thoracic surgical sites with benzoyl peroxide, in addition to other cutaneous antiseptic agents. Managing fecal or urinary incontinence should also be prioritized to minimize soilage in the early postoperative period. Furthermore, broader gram-negative coverage should be considered for antibiotic prophylaxis in lumbar/lumbosacral fusion surgeries. Attention should be paid to craniotomy/craniectomy sites in the early postoperative period to prevent contamination from the surrounding environment. Lastly, the study recommends routine preoperative screening for MRSA and MSSA, with appropriate decolonization measures for colonized patients or those with a history of infection.
This groundbreaking study provides valuable insights into the differences in microorganisms causing SSIs after cranial and spinal surgeries. The findings have the potential to improve surgical practices and enhance patient outcomes. Further research is needed to validate these results and explore additional preventive measures.