Surgical site infection risk factors

Surgical site infection risk factors

Of 16,513 patients in a study, 1.20% required at least one further operation to treat a surgical site infection (SSI). Wound leak (odds ratio [OR]: 27.41), dexamethasone use (OR: 3.55), instrumentation (OR: 2.74) and operative time >180 minutes (OR: 1.85) were statistically significant risk factors for reoperation 1).


It is still discussed if the dual use increases the risk of surgical site infections (SSI).Increase of extent of tumor resection using intraoperative magnetic resonance imaging (iMRI) is evident. SSI rate is within the normal range of neurosurgical procedures. A dual-use iMRI suite is a safe concept 2).


Despite the general consensus on the use of single-dose antimicrobial prophylaxis (AMP) in instrumented spine surgery, evidence supporting this approach is not robust. Analysis of individual categories of data suggests that 72 h prophylaxis was the most important factor for minimizing the risk of wound infection in a study group 3).


Cassir et al. identified the following independent risk factors for SSI postcranial surgery: intensive care unit (ICU) length of stay ≥7 days (odds ratio [OR] = 6.1; 95% confidence interval [CI], 1.7-21.7), duration of drainage ≥3 days (OR = 3.3; 95% CI, 1.1-11), and cerebrospinal fluid leakage (OR = 5.6; 95% CI, 1.1-30).

For SSIs postspinal surgery, they identified the following: ICU length of stay ≥7 days (OR = 7.2; 95% CI, 1.6-32.1), coinfection (OR = 9.9; 95% CI, 2.2-43.4), and duration of drainage ≥3 days (OR = 5.7; 95% CI, 1.5-22) 4).

Nuchal thickness and subcutaneous fat thickness are associated with SSI, in patients undergoing posterior cervical spine surgery. The risk of infection increases with very thin and very thick nuchal measurements 5).


Local subcutaneous fat thickness is a better indicator for predicting incision infection compared with BMI. In diabetic patients undergoing lumbar surgery, actively controlling blood glucose fluctuations, restoring normal diet early after surgery, and optimizing surgical procedures to reduce trauma and operative time can effectively reduce the risk of infection after posterior lumbar surgery 6).


1)

Patel S, Thompson D, Innocent S, Narbad V, Selway R, Barkas K. Risk factors for surgical site infections in neurosurgery. Ann R Coll Surg Engl. 2019 Mar;101(3):220-225. doi: 10.1308/rcsann.2019.0001. Epub 2019 Jan 30. PubMed PMID: 30698457; PubMed Central PMCID: PMC6400918.
2)

Wach J, Goetz C, Shareghi K, Scholz T, Heßelmann V, Mager AK, Gottschalk J, Vatter H, Kremer P. Dual-Use Intraoperative MRI in Glioblastoma Surgery: Results of Resection, Histopathologic Assessment, and Surgical Site Infections. J Neurol Surg A Cent Eur Neurosurg. 2019 Jul 4. doi: 10.1055/s-0039-1692975. [Epub ahead of print] PubMed PMID: 31272122.
3)

Maciejczak A, Wolan-Nieroda A, Wałaszek M, Kołpa M, Wolak Z. Antibiotic prophylaxis in spine surgery: a comparison of single-dose and 72-hour protocols. J Hosp Infect. 2019 Apr 30. pii: S0195-6701(19)30186-0. doi: 10.1016/j.jhin.2019.04.017. [Epub ahead of print] PubMed PMID: 31051190.
4)

Cassir N, De La Rosa S, Melot A, Touta A, Troude L, Loundou A, Richet H, Roche PH. Risk factors for surgical site infections after neurosurgery: A focus on the postoperative period. Am J Infect Control. 2015 Aug 20. pii: S0196-6553(15)00756-7. doi: 10.1016/j.ajic.2015.07.005. [Epub ahead of print] PubMed PMID: 26300100.
5)

Porche K, Lockney DT, Gooldy T, Kubilis P, Murad G. Nuchal thickness and increased risk of surgical site infection in posterior cervical operations. Clin Neurol Neurosurg. 2021 Apr 25;205:106653. doi: 10.1016/j.clineuro.2021.106653. Epub ahead of print. PMID: 33984797.
6)

Peng W, Liang Y, Lu T, Li M, Li DS, Du KH, Wu JH. Multivariate analysis of incision infection after posterior lumbar surgery in diabetic patients: A single-center retrospective analysis. Medicine (Baltimore). 2019 Jun;98(23):e15935. doi: 10.1097/MD.0000000000015935. PubMed PMID: 31169714.

Rheumatoid meningitis

Rheumatoid meningitis

Central nervous system involvement in rheumatoid arthritis (RA) is a rare and treatable, yet potentially fatal, condition that is frequently recognized only by autopsy 1).

Till 2018 approximately 25 case reports were published describing various clinical symptoms of this condition, including confusionfocal neurological deficits, seizures, stroke-like episodes, and Parkinsonism 2).

Rheumatoid meningitis (RM) is a rare complication of rheumatoid arthritis (RA) and has a high mortality rate. It can present as a first diagnosis of RA, in long-standing disease, or in active or well-controlled disease. Neurological manifestations vary widely.

RM must be considered in adult patients with or without RA diagnosis 3).

RM affected adults with an average age of 62 years, with or without a previous diagnosis 4).

The most common clinical manifestations were transient focal neurological signs (64.6%), systemic symptoms (51.3%), episodic headache (50.4%), and neuropsychiatric alterations (47.7%). Joint manifestations were present in only 27.4% of cases 5).

In a systematic review brain magnetic resonance imaging showed unilateral or bilateral involvement, predominantly supratentorial and frontoparietal. Both pachy- and leptomeninges were affected, the latter more frequently (82.88%). The laboratory findings included increased levels of rheumatoid factor (89.71%), anti-cyclic citrullinated peptide (89.47%), C-reactive protein (82.54%), and erythrocyte sedimentation rate (81.81%). Cerebrospinal fluid analysis showed an increase in the protein level (76.14%), with pleocytosis (85.19%) of mononuclear predominance (89.19%). Biopsy was performed in 72.52% of the patients 6).

MRI findings usually exhibit non-specific meningeal thickening and contrast enhancement 7).

CSF studies may be normal or show non-specific lymphocytic pleocytosis with protein elevation. The significance of increased Rheumatoid factor (RF) in the CSF is unclear 8).

Corticosteroid pulse therapy was the main induction therapy 9).

RA activity and time with the disease were associated with a worse prognosis.

Disease relapse occurred in 31.17% of patients, while 54.54% had a full recovery. 10).

Villa et al. from the Hospital Clínico Universidad de ChileSantiago, aimed to describe the characteristics of the disease, including clinical, imaging, and laboratory findings, treatment, outcomes, and prognosis reported in the literature.

They included 103 studies with 130 cases. RM affected adults with an average age of 62 years, with or without a previous diagnosis. RA activity and time with the disease were associated with a worse prognosis. The most common clinical manifestations were transient focal neurological signs (64.6%), systemic symptoms (51.3%), episodic headache (50.4%), and neuropsychiatric alterations (47.7%). Joint manifestations were present in only 27.4% of cases. Brain magnetic resonance imaging showed unilateral or bilateral involvement, predominantly supratentorial and frontoparietal. Both pachy- and leptomeninges were affected, the latter more frequently (82.88%). The laboratory findings included increased levels of rheumatoid factor (89.71%), anti-cyclic citrullinated peptide (89.47%), C-reactive protein (82.54%), and erythrocyte sedimentation rate (81.81%). Cerebrospinal fluid analysis showed an increase in the protein level (76.14%), with pleocytosis (85.19%) of mononuclear predominance (89.19%). Biopsy was performed in 72.52% of the patients. Corticosteroid pulse therapy was the main induction therapy. Disease relapse occurred in 31.17% of patients, while 54.54% had a full recovery.

RM must be considered in adult patients with or without RA diagnosis. These findings may aid clinicians in timely RM diagnosis and treatment, thus improving its outcomes 11).

A patient with a 30-year history of RA, well-controlled with methotrexate therapy, presented with new-onset seizures. Magnetic resonance imaging showed leptomeningeal and pachymeningeal enhancement. A de novo workup resulted in a diagnosis of RM.

Cerebrospinal fluid findings for RM are nonspecific, typically lymphocytic pleocytosis; however, they can be neutrophilic, as in this case. Magnetic resonance imaging findings consist of leptomeningeal and pachymeningeal enhancement but can also involve the parenchyma. The diagnosis is typically confirmed with meningeal biopsy. Treatment involves high-dose corticosteroids or immunomodulatory therapy, or both. Long-term follow-up with radiologic surveillance typically ranges from improvement to resolution 12).


Finkelshtein V, Lampl Y, Lorberboym M, Kanner A, Ben-Ami Raichman D, Dabby R, Tanay A. Self-limited Rheumatoid Meningitis as a Presenting Symptom of Rheumatoid Arthritis. Isr Med Assoc J. 2018 Apr;20(4):262-264. PubMed PMID: 29629737.


1)

Bathon JM, Moreland LW, DiBartolomeo AG. Inflammatory central nervous system involvement in rheumatoid arthritis. Semin Arthritis Rheum 1989; 18: 258-66.
2)

Finkelshtein V, Lampl Y, Lorberboym M, Kanner A, Ben-Ami Raichman D, Dabby R, Tanay A. Self-limited Rheumatoid Meningitis as a Presenting Symptom of Rheumatoid Arthritis. Isr Med Assoc J. 2018 Apr;20(4):262-264. PubMed PMID: 29629737.
3) , 4) , 5) , 6) , 9) , 10) , 11)

Villa E, Sarquis T, de Grazia J, Núñez R, Alarcón P, Villegas R, Guevara C. Rheumatoid meningitis: a systematic review and meta-analysis. Eur J Neurol. 2021 May 9. doi: 10.1111/ene.14904. Epub ahead of print. PMID: 33966315.
7)

Cianfoni A, Falcone C, Faustini F, et al. Rheumatoid leptomeningitis: magnetic resonance imaging and pathologic findings – a case report. J Neuroimaging 2010; 20: 192-4.
8)

Kim HY, Park JH, Oh HE, Han HJ, Shin DI, Kim MH. A case of rheumatoid meningitis: pathologic and magnetic resonance imaging findings. Neurol Sci 2011; 32: 1191-4.
12)

Parsons AM, Zuniga LA, Hoxworth JM, Lyons M, Aslam F, Goodman BP. Rheumatoid Meningitis: A Case Review. Neurologist. 2018 May;23(3):83-85. doi: 10.1097/NRL.0000000000000158. PubMed PMID: 29722740.

Ocular toxocariasis

Ocular toxocariasis

see Toxocariasis.

see also Cerebral toxocariasis


Ocular toxocariasis (OT) is a zoonotic infection caused by larval stages of Toxocara canis and T. cati.

systematic review and meta-analysis aimed to evaluate the global prevalence of OT.

Five English (PubMedScopusScienceDirectWeb of Science, and Google Scholardatabases were explored and 101 articles met the inclusion criteria.

The pooled prevalence (95% confidence interval) of OT was higher in immunological studies (9%. 6-12%) than in studies that applied ophthalmic examination (1%. 1-2%). The lower middle income country had the highest prevalence (6%. 2-12%) as well as the African region (10%. 7-13%). The highest infection rate (4%. 2-7%) was detected in the 1-25 mean age group.

Regular anthelmintic treatment of cats and dogs, and removal of animal feces from public places must be considered 1).


1)

Badri M, Eslahi AV, Olfatifar M, Dalvand S, Houshmand E, Abdoli A, Majidiani H, Eslami A, Zibaei M, Johkool MG, Taghipour A, Hashemipour S. Keys to Unlock the Enigma of Ocular Toxocariasis: A Systematic Review and Meta-analysis. Ocul Immunol Inflamm. 2021 Apr 28:1-12. doi: 10.1080/09273948.2021.1875007. Epub ahead of print. PMID: 33909531.
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