Intraoperative Cultures in Endoscopic Endonasal Neurosurgical Cases Show Persistent Surgical Site Colonization with Pathogenic Bacteria after Preparation

Introduction: Surgical infections can be devastating in patients undergoing endoscopic endonasal surgery, yet optimal surgical site preparation techniques have not been clearly determined. Furthermore, the profile and origin of pathogens that ultimately go on to cause post-operative infections in these patients remain unclear.

Objectives: Here we sought to determine the effect of surgical site preparation techniques on reducing the presence of potentially pathogenic bacteria at the skull base in patients undergoing endoscopic endonasal surgery.

Methods: This is an ongoing prospective single-center study in which surgical site cultures are taken intranasally before surgical site preparation with betadine, after surgical site preparation, and from the skull base after bony exposure is complete. Here we report the preliminary results for all adult patients enrolled who underwent elective endoscopic endonasal surgery between August 1st and September 5th, 2023. Patients will be followed for up to 90 days postoperatively to identify surgical site infections. All patients received a standard dose of intraoperative cefazolin or vancomycin, and no patients were treated with post-operative antibiotics.

Results: Data was collected from 11 patients undergoing endoscopic endonasal surgery during this period. Patients were 67% female with mean age 56.5 ± 18.2. 10 patients underwent resection of a pituitary adenoma, while 1 underwent resection of a tuberculum meningioma. Pre-preparation cultures were positive in all patients. Post-preparation cultures were positive in 10 patients, though 8 patients showed a reduction in bacterial burden after preparation. Cultures obtained from the sphenoid after bony exposure was complete were positive in 8 patients. 3 of these patients had cultures that grew pathogenic bacteria with invasive properties. Pathogens cultured from bone included Staphylococcus lugdunensis, methicillin-sensitive Staphylococcus aureus, and multi-drug resistant Klebsiella aerogenes. Two patients with a positive bone culture had lumbar drains placed intraoperatively, and one patient with a positive bone culture had a lumbar puncture performed post-operative day 3 due to clinical concern for meningitis – cerebrospinal fluid cultures were negative and protein, glucose, and cells counts were within normal limits in all three cases. No patients to date have experienced post-operative infections.

Conclusion: Patients undergoing endoscopic endonasal surgery have notable bacteria burdens with potentially pathogenic species at the surgical site even after intraoperative surgical site preparation. Preliminarily this does not correlate immediately with post-operative central nervous system infection. As our study continues, we hope to identify optimal intraoperative surgical site preparation techniques and determine whether patients who ultimately develop post-operative infections become infected by pathogens present on intraoperative cultures, or other infectious agents acquired at a different date.

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Artikel online veröffentlicht:
05. Februar 2024