scholarly journals 780: ANTIBIOTIC PROPHYLAXIS IN POSTOPERATIVE NEUROSURGICAL PATIENTS WITH A DRAIN: BRIEF VERSUS EXTENDED

2021 ◽  
Vol 50 (1) ◽  
pp. 384-384
Author(s):  
Kelsey Smith ◽  
Erica Bergeron ◽  
Ryan Hire ◽  
Elisabeth Chandler ◽  
Vera Rosado-Odom
Keyword(s):  
Antibiotic Prophylaxis ◽  
Neurosurgical Patients

scholarly journals Follow-up Study on the Effect of Risk-Stratified, Protocol-Based Perioperative Antibiotic Prophylaxis on Postoperative Infections in a Tertiary Care Neurosurgical Department over 10 Years (2007–2016)

2018 ◽  
Vol 07 (01) ◽  
pp. 029-035
Author(s):  
Ashutosh Agarwal ◽  
Sachin Borkar ◽  
Arti Kapil ◽  
Jyotsna Dabral ◽  
Ashish Suri ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Care Center ◽  
Tertiary Care ◽  
Prophylactic Antibiotic ◽  
Follow Up Study ◽  
Retrospective Audit ◽  
Neurosurgical Patients ◽  
Variable Duration ◽  
Tract Infections

Abstract Objective To study the effectiveness of risk-stratified prophylactic antibiotic policy on meningitis, surgical site, and extraneurosurgical site infections among postoperative neurosurgical patients from the year 2007 to 2016. This is a follow-up study for a similar analysis done from 1994 to 2006, which is published in Neurosurgery. Methods Retrospective audit of 30,251 consecutive neurosurgical cases from January 2007 through December 2016 at a tertiary care center with culture positivity in samples taken from patients showing clinical/radiologic evidence of infection as an objective marker of postoperative infection. Risk-stratified, variable-duration antibiotic prophylaxis policy was followed over 10 years; it was modified in the year 2014, and infections from 2007 to 2013 were compared with 2014 to 2016. Results Over 10 years, there were 2,782 infections in 2,193 (9.45%) patients with meningitis in 281 (0.96%), bloodstream infections in 596 (2.05%), respiratory infections in 913 (3.11%), urinary tract infections (UTIs) in 697 (2.30%), and wound infections in 295 (1.02%) patients. On comparison, the proportion of infections between 2014 and 2016 was significantly lower than that between 2007 and 2013 (4.61 ± 0.14% vs. 11.52 ± 2.2%, p = 0.001). The most common microorganisms were non–lactose-fermenting gram-negative bacilli, followed by Klebsiella and Escherichia coli. The proportion of gram-positive cocci (GPC) was 16.2% with methicillin-resistant Staphylococcus aureus (MRSA) accounting for 5.5% cases. Conclusion A risk-stratified, variable-duration prophylactic antibiotic protocol helps in reducing postoperative meningitis, surgical site, and extraneurosurgical site infections in neurosurgical patients, and prophylaxis with first-generation cephalosporin and aminoglycoside is effective.

scholarly journals Investigation of Surgical Site Infection Outbreak Among Neurosurgical Patients

2020 ◽  
Vol 41 (S1) ◽  
pp. s306-s306
Author(s):  
Luísa Ramos ◽  
Jussara Pessoa ◽  
Leonardo Santos ◽  
Carlos Starling ◽  
Braulio Couto
Keyword(s):  
Length Of Stay ◽  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Hospital Admissions ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Site Infection ◽  
Epidemic Period ◽  
Neurosurgical Patients ◽  
London Protocol

Background: The infection control service of a private hospital in Belo Horizonte, Brazil, performs continuous surveillance of surgical patients according to the CDC NHSN protocols. In a routine analysis of the neurosurgical service, we identified a subtle increase in the incidence of surgical site infection (SSI): in 5 months (June–October 2018), 6 patients developed an SSI. From January 2017 until May 2018, there were no cases of infection in neurosurgery, which led us to suspect an outbreak. Methods: A cohort study was used to investigate the factors associated with risk of SSI. We investigated the following variables: ASA score, number of hospital admissions, age, preoperative hospital length of stay, duration of surgery, wound class, general anesthesia, emergency, trauma, prosthesis, surgical procedures, surgeon. Furthermore, 9 key steps were followed to investigate the outbreak: case definition (step 1), search for new SSI cases (step 2); confirmation of the outbreak (step 3); analysis of SSI cases by London Protocol (step 4); analysis of the cohort data (step 5); inspections in the surgical ward (step 6); qualitative and quantitative reports sent to the neurosurgical departments (step 7); continuing with active surveillance (stage 8); announcement of research findings (step 9). Results: The outbreak was confirmed: SSI incidence in the pre-epidemic period (January–May 2018) was 0 of 218 (0%); in the epidemic period (June–October 2018), SSI incidence was 6 of 94 (6.4%) (P < .001). We identified 3 SSI etiologic agents: 2 Klebsiella pneumoniae, 2 S. aureus, and 1 Serratia marcescens. It was unlikely that there was a common source for the outbreak. We identified the following risk factors: second or third hospital admissions (RR, 3.7; P = .041), and preoperative hospital length of stay: SSI patients (4.3±5.7 days) versus control patients (0.7 ± 2.1 days) (P = .048). None of the surgeons presented an SSI rate significantly different from each other. We used the London protocol to identify antibiotic prophylaxis failures in most cases. Conclusions: New cases of infections can be prevented if the length of preoperative hospital stay becomes as short as possible and, most importantly, if antibiotic prophylaxis does not fail.Funding: NoneDisclosures: None

TRACHEOSTOMY IN CRITICALLY ILL NEUROSURGICAL PATIENTS

2001 ◽  
Vol 5 (1) ◽  
pp. A5-A5
Author(s):  
Keith Y.C. Goh ◽  
Wendy Teoh ◽  
Chumpon Chan
Keyword(s):  
Critically Ill ◽  
Neurosurgical Patients

Effects of Intermittent Pneumatic Calf Compression On Postoperative Thrombin and Plasmin Activity

1986 ◽  
Vol 56 (02) ◽  
pp. 198-201 ◽  
Author(s):  
Jeffrey Weitz ◽  
Jost Michelsen ◽  
Kenneth Gold ◽  
John Owen ◽  
Duncan Carpenter
Keyword(s):  
Enzyme Activity ◽  
Fibrinopeptide A ◽  
Plasmin Activity ◽  
Neurosurgical Patients ◽  
The Mean ◽  
Calf Compression

SummaryA previous study of neurosurgical patients demonstrated an imbalance between thrombin and plasmin action following surgery. The present study was designed to determine the effect of intermittent pneumatic calf compression on postoperative enzyme activity. Fibrinopeptide A (FPA) and Bβ 1-42 levels, reflecting thrombin and plasmin action respectively, were measured daily in patients undergoing elective craniotomy. Two of 9 patients not receiving calf compression developed positive fibrinogen leg scans, while none of 5 patients receiving prophylaxis had positive scans. Calf compression was associated with a markedly altered pattern of changes in the fibrinopeptide values following surgery. Without compression, there was perturbation of the balance between thrombin and plasmin action on the day after surgery as reflected by an increase in the FPA/Bβ 1-42 ratio. In contrast, in those receiving prophylaxis there was no change in this ratio on the first postoperative day. Calf compression both blunted the mean postoperative increase in the FPA level (1.8 nM vs 4.7 nM; p <.05) and augmented the mean Bβ 1-42 value (3.0 nM vs 0.2 nM; p <.05) so that the mean increase in the FPA/ Bβ 1-42 ratio was only 0.1 with calf compression as compared to 2.2 without it (p <.05). Systemic modulation of both the coagulation and fibrinolytic pathways thus occurred in association with calf compression.

Sign in / Sign up

Export Citation Format

Share Document