Postoperative infections: Aetiology, incidence and risk factors among neurosurgical patients in Mthatha, South Africa

S Afr Med J. 2020 Apr 29;110(5):403-408. doi: 10.7196/SAMJ.2020.v110i5.13779.

Abstract

Background: Despite progress in hospital care, infections continue to represent one of the major complications among hospitalised patients.

Objectives: To determine the aetiology and incidence of hospital-acquired infections and their associated risk factors following neurosurgical procedures.

Methods: A retrospective study was conducted from October 2013 to September 2014. Data including demographics, hospitalisation period, type of operation and primary diagnosis were collected. Post-surgical infections were confirmed microbiologically. SPSS (Statistical Package for the Social Sciences) version 23 was used for statistical analysis.

Results: Among a total of 1 688 patients who underwent neurosurgical operations, the incidence of post-surgical infections was 4.2% per year. Post-surgical infections were significantly associated with craniotomy (p<0.0001), prolonged stay in hospital (≥30 days) (p=0.008), and patient age ≥35 years (p=0.05). Staphylococcus aureus was the most frequently isolated pathogen (19.7%), followed by Klebsiella pneumoniae (12.7%). A total of 42.9% of S. aureus isolates were methicillin-resistant S. aureus (MRSA), but all these isolates were susceptible to vancomycin; 44.4% of K. pneumoniae isolates were extended-spectrum beta-lactamase (ESBL)-positive, but were susceptible to carbapenems, piperacillin-tazobactam and amikacin.

Conclusions: Post-surgical infections remain an important problem in neurosurgery. Increased resistance to causative pathogens is a major concern.

MeSH terms

  • Adolescent
  • Age Factors
  • Anti-Bacterial Agents / therapeutic use
  • Craniotomy / adverse effects
  • Cross Infection / epidemiology*
  • Cross Infection / microbiology
  • Cross-Sectional Studies
  • Drug Resistance, Bacterial
  • Female
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Klebsiella Infections / epidemiology
  • Length of Stay / statistics & numerical data
  • Male
  • Retrospective Studies
  • Risk Factors
  • South Africa / epidemiology
  • Staphylococcal Infections / epidemiology
  • Surgical Wound Infection / epidemiology*
  • Surgical Wound Infection / microbiology
  • Ventriculoperitoneal Shunt / adverse effects

Substances

  • Anti-Bacterial Agents