Introduction: Postoperative central nervous system infection (PCNSI) and wound infection are serious complications after neurosurgical intervention and can lead to increased financial burdens and poor patient outcomes. Moreover, there is a dearth of scientific literature examining the prevalence and impact of PCNSIs in modernized, resource-limited neurosurgical centers. This study examined the prevalence and causative pathogens of PCNSIs and wound infections at a resource-limited, neurosurgical center that serves an underprivileged patient population in South Asia.
Methods: This was a retrospective analysis of the medical records of all 363 neurosurgical cases operated between June 2012 and June 2013 of an updated, resource-limited neurosurgical center. Data from all operative neurosurgical cases during the twelve-month period were included in the study.
Results: The results indicated 69 of the 363 surgical cases had abnormal CSF glucose or cellularity post-operatively. Of these 69 cases, 5 had positive CSF cultures, and 2 others also had positive CSF cultures but with normal CSF glucose and cellularity. The PCNSIs with positive CSF cultures (9.86%) all had gram-negative bacteria with Pseudomonas aeruginosa (n=5), Escherichia coli (n=1), or Klebsiella (n=1). There were 24 cases of wound infections of which16 were culture-positive with Klebsiella (n=6), Pseudomonas (n=3), E. coli (n=3), Staph Aureus (n=3), and Proteus Vulgaris (n=1). Duration of surgery, age, sex, CSF leak, pre-operative stay, neurosurgical procedure, and mortality were not predictive for culture positive PCNSI.
Conclusions: This study shows an increasing prevalence of gram-negative organisms in CSF cultures from PCNSIs. Given that these patients received broad antibiotic prophylaxis covering gram-negative and gram-positive organisms, the prevalence of gram-negative organisms found in PCNSIs and wound infections could indicate an increase in antibiotic resistant strains. Decreasing PCNSIs, especially those due to antibiotic resistant gram-negative organisms, can help decrease costs, improve outcomes, and allow better resource allocation in resource-limited neurosurgical settings.
Patient Care: This research addresses gaps in the literature on Postoperative central nervous system infections (PCNSIs) by examining the prevalence and types of PCNSIs and wound infections in a modernized, resource-limited neurosurgical setting. It helps us find ways to manage costs and reallocate resources by understanding the causative agents of PSCNIs and how we can better target them with prophylactic antibiotics.
Learning Objectives: 1) Describe the importance of understanding the prevalence and causative pathogens of PCNSIs and wound infections at modernized, resource-limited neurosurgical settings.
2) Discuss the importance of adjusting prophylactic antibiotic coverage to target gram-negative organism in settings with an increased prevalence of postoperative, gram-negative bacillary meningitis.
3) Identify the potential benefits of decreasing PCNSIs and wound infections in resource-limited neurosurgical settings that serve underprivileged populations.