Outcomes of surgical site infection following cranial surgery from a UK Tertiary Centre

Background

The evidence guiding management of cranial surgical site infections (SSI) is sparse with limited data on optimal duration of antimicrobial therapy. There is a lack of published data on approach to and the outcomes of cranial SSI management.

Methods

We retrospectively reviewed patients from Oxford University Hospitals, UK requiring revision surgery for SSI following primary craniotomy, craniectomy and cranioplasty between January 2019 and April 2022, and reviewed outcomes at 24 months. Data were collected on patient characteristics, diagnosis, management and outcome. Analysis was performed in R.

Results

Of 94 patients included, 44% were male and median age was 51 years [IQR: 42-63]). During surgical inspection, 40% of infections were found to involve only superficial structures, 33% involved the extradural space, and 27% extended to the subdural space.

S.aureus (24%) and C.acnes (22%) were the most frequently identified organisms, while all gram-negative bacilli combined accounted for 26% of cases. Rates of repeat surgery for infection were not significantly different between superficial compared to deep SSI (26% v 28%, p=0.499). On univariate analysis, corticosteroid use (OR 3.51 [1.24–10.00], p =0.018) and prolonged antibiotic therapy (OR 1.34 [1.11–1.62], p=0.002) were significantly associated with adverse outcome

Conclusions

These findings underscore the complexity of cranial SSIs and variation in presentation. Failure in this cohort was not uncommon, and practitioners should be particularly vigilant in the management of ‘superficial’ infections. Developing a national consensus guideline would be an important step towards standardising care and improving patient outcomes in this challenging cohort.