Abstract | BACKGROUND: Endonasal endoscopic skull base surgery (ESBS) is perceived as having a high risk of infection because it is performed through the sinuses, which are not sterile. OBJECTIVE: To identify the bacteriological characteristics, incidence, mortality, and risk factors for intracranial infection after ESBS. METHODS: A retrospective analysis of the first 1,000 ESBS procedures performed at the University of Pittsburgh Medical Center from 1998 to 2008. RESULTS: In 18 cases (1.8%), the patient developed meningitis. In 2 cases, the patient died within 2 months after surgery, of noninfectious causes. In 11 cases, cerebrospinal fluid (CSF) cultures had positive results. There were no predominant pathogens. Male sex (odds ratio [OR], 3.97 [95% confidence interval {CI}, 1.21-13.03]; P = .02), history of a craniotomy or endonasal surgery (OR, 4.77 [95% CI, 1.68-13.56]; P = .02), surgery with higher levels of complexity (OR, 6.60 [95% CI, 1.77-24.70]; P = .003), the presence of an external ventricular drain or ventriculoperitoneal shunt at the time of surgery (OR, 6.38 [95% CI, 1.07-38.09]; P = .005), and postoperative CSF leak (OR, 12.99 [95% CI, 4.24-39.82]; P < .001) were risk factors for infection. CONCLUSION: The incidence of infection of 1.8% in ESBS is comparable to that in open craniotomy. The most important risk factor was a postoperative CSF leak. All patients recovered from their infection.
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Authors | Yuriko Kono, Daniel M Prevedello, Carl H Snyderman, Paul A Gardner, Amin B Kassam, Ricardo L Carrau, Karin E Byers |
Journal | Infection control and hospital epidemiology
(Infect Control Hosp Epidemiol)
Vol. 32
Issue 1
Pg. 77-83
(Jan 2011)
ISSN: 1559-6834 [Electronic] United States |
PMID | 21121816
(Publication Type: Journal Article)
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Topics |
- Adolescent
- Adult
- Aged
- Brain Abscess
(epidemiology, mortality)
- Confidence Intervals
- Cross Infection
(epidemiology, etiology, mortality)
- Endoscopy
(adverse effects, methods)
- Female
- Humans
- Male
- Meningitis
(epidemiology, mortality)
- Middle Aged
- Nose
(microbiology)
- Pennsylvania
(epidemiology)
- Postoperative Complications
(epidemiology, etiology, mortality)
- Retrospective Studies
- Risk Factors
- Skull Base
(surgery)
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