976. Post-operative Infection after Surgery of Brain Tumors: a Five-year Review of Common Pathogens, Presentation and other Associated Factors
Session: Poster Abstract Session: CNS Infection
Friday, October 9, 2015
Room: Poster Hall
Posters
  • IDSAPDFposter.pdf (1.5 MB)
  • Background: Intracranial surgeries for brain tumors have a 2-4% postoperative infection rate.  Limited data is available regarding common pathogens and associated risk factors. We present a descriptive study of patients with these neurosurgical infections during a 5 year period.

    Methods: Patients who had an infection after brain tumor surgery at our institution from 2010-2014 were retrospectively reviewed. Patients with primary surgery outside our hospital or shunt surgery with a shunt infection were excluded. 75 patients with infections were identified after craniectomy (67 total: 47 supra-tentorial, 20 posterior fossa), burr hole procedure (n=5;), and transnasal-transsphenoidal operation (n=3).

    Results: Average age was 51 years (range 20-80 years), 41%female. The most common pathology was glioma in 41%, followed by meningioma (16%) and metastases (11%).  Median interval between surgery and diagnosis of infection was 1 month. 35% had history of cranial radiation before tumor surgery. Active radiation and chemotherapy between tumor surgery and diagnosis of infection was observed in 33% and 31% respectively. 72% had post-op wound issues (wound dehiscence, drainage and pseudo-meningocele). The most common type of infection was meningitis (49%), epidural abscess (31%), brain abscess (17%), cerebritis and ventriculitis (1 patient each). The most common pathogen was MSSA (32%) followed by Coagulase negative staphylococcus (CONS) (20%), P. acnes (8%), Enterobacter (7%), Klebsiella pneumonaie (5%), and MRSA (3%). Forty-three patients underwent surgical washout, 20 of whom had titanium mesh placed. Twenty-six of 75 patients (35%) had re-admissions for recurrent/resistance infection, 10 of whom had titanium mesh placed previously. Two patients (3%) died with 90 days of diagnosis of infection.

    Conclusion: Most post-operative infections after brain tumor surgery are diagnosed within a month of index surgery. MSSA and CONS are the most common pathogens. The infection recurrence and readmission rate among these patients is relatively high at 35%, and is even greater in the presence of titanium mesh (50%). With aggressive and appropriate treatment (antibiotics and/or wound wash-out), 90 day mortality remains relatively low (3%).

    Tannaz Asadi, MD, Internal Medicine, Fairview hospital, cleveland, OH, Adarsh Bhimraj, MD, Neurologic Infectious Diseases, Cleveland Clinic, Cleveland, OH, Carlos Isada, MD, Infectious Diseases, Cleveland Clinic, Cleveland, OH, Allireza Mohammadi, MD, Cleveland Clinic, Cleveland, OH and Lulette Tricia Bravo, MD, Infectious Disease, Cleveland Clinic Foundation, Cleveland, OH

    Disclosures:

    T. Asadi, None

    A. Bhimraj, None

    C. Isada, None

    A. Mohammadi, None

    L. T. Bravo, None

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