Emerging Antibiotics Resistance Patterns in Postcranial Surgery CNS Infections, A Tertiary Center Experience
Background: Postoperative central nervous system infections (PCNSI) in patients undergoing neurosurgical procedures represent a serious problem that requires immediate attention. They commonly require prolonged antibiotic treatment and additional surgical interventions for successful eradication and frequently result in significant morbidity, prolonged hospitalization, and increased health care expenses. There is variability on the rate of PCNSI in literature (1 – 11 %) probably due to differences in operational definitions and methodologies used. There is limitation in reports concerning this issue from underdeveloped nations and resource constrained setups like ours.
Objective: The objective of the study is to assess the incidence, associated factors, clinical and microbiologic profile of postoperative CNS infections at Tikur Anbessa Specialized Hospital.
Methodology: This is a hospital based prospective cohort study of patients who underwent elective trans-cranial surgery from November 1, 2018 – September 30, 2019, at Tikur Anbessa Specialized Hospital. Patients were followed for the development of deep CNS infections according to the CDC/NHSN criteria (2008) till discharge. Clinical data was collected using well designed questionnaire and encoded to IBM/SPSS 25. Bivariate and multivariate correlational analysis was done to pick strongly associated variables with p value <.05 considered significant.
Results: A total of 256 surgeries were included in the study out of which 29(11.3%) fulfilled the criteria for diagnosis of PCNSIs. Meningitis/ventriculitis were the commonly diagnosed infection types (82.8%). 41.4% of the cases are instrument related infections (EVD/VP-shunt). Infections are common in the infratentorial surgery group contributing to 55.2% of cases. The median period of diagnosis was 9th postop day. Fever (100%) and meningismus (75.9%) are the common clinical signs. Deterioration in mentation or confusion was seen in 55.2% of the patients. Seventeen (58.9%) patients had growth of etiologic organisms at least from a single sample. The strongest independent risk factor is postoperative CSF leak (OR=22). Superficial incisional infections (OR=5), EVD stay >3days (OR=7) and ICU stay >3days (OR=5) are also independent risk factors. Acinetobacter spp. and Klebsiella pneumoniae are the frequently isolated organisms (37.9% and 27.6% respectively). Acinetobacter spp. show 100% resistance for Ceftazidime, 80% resistance for Meropenem, and 50% resistance for Amikacin. Five patients had documented death from sepsis or neurologic complication of infection. This is ~20% of the overall surgical mortality.
Conclusion: There is higher incidence of postoperative CNS infections (11.3%) in comparison to other studies. The moderately high rates of postsurgical CSF leak and superficial incisional infections are strong risk factors in our setup. Prolonged EVD stay and prolonged ICU stay are also risk factors especially for Gram negative bacterial infections. The emerging multidrug resistance patterns of Acinetobacter spp. are also a challenge in our setup. Mortality from PCNSIs has a significant contribution to the overall surgical mortality (~20%).
Keywords: postcranial Surgery, CNS infections, neurosurgery, Postoperative central nervous system infection (PCNSI)
Citation: Gizaw A, Sahlu A, Bogale T “Emerging Antibiotics Resistance Patterns in Postcranial Surgery CNS Infections, A Tertiary Center Experience”. SVOA Neurology 2:5 (2021) Pages 162-175.
