Neurosurgery surgical site infections in Cameroon: diagnosis, management and associated factors

Abstract

Background: Surgical site infections (SSI) are a public health issue. Most neurosurgical cases are clean; hence, surgical site infections are not as common. This subject has not been extensively studied in literature, worst of all in resource-limited settings where SSI increases health care burden.

Objective: To examine clinical and paraclinical presentations, therapeutic approaches, and factors associated with SSI in two neurosurgery departments.

Materials and methods: A retrospective observational study was conducted in the neurosurgery departments of Douala General and Laquintinie hospitals using medical records of patients who had surgery between January 1, 2018, to December 31, 2022. Patients who had surgery for infectious etiologies and those with incomplete medical records were excluded. Univariate and bivariate analyses were done for associations. A p-value less than 0.05 was considered significant.

Results: We included 386 patient records. SSI occurred in 7.3 %, with a mean age of occurrence of 45+/-18.6 years. The most frequently isolated germs were Pseudomonas aeruginosa (43.7 %) and Klebsiella pneumoniae (37.4 %). Amikacin and carbapenems were the most prescribed antibiotics after culture and sensitivity. Factors associated with SSI occurrence included: being HIV positive (p < 0.001), long operative time (p = 0.001), NNISS score > 0 (p = 0.004), having a clean surgery (p = 0.008), having multi-level spinal surgery (p = 0.002), developing pressure sores (p = 0.021) or respiratory infections (p = 0.007) postoperatively.

Conclusion: The most common germs isolated in our setting are gram-negative bacilli. Empirical treatment of SSI in neurosurgery needs further investigations and adjustments.

Keywords: Cameroon; Empirical antibiotics; Neurosurgery; Surgical site infection.