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%).
C. Isada, None
A. Mohammadi, None
L. T. Bravo, None