Nosocomial infection: hospital infection surveillance and control

Do Preoperative Corticosteroid Injections Increase the Risk for Infections or Wound Healing Problems After Spine Surgery?: A Swiss Prospective Multicenter Cohort Study

STUDY DESIGN

A prospective multicenter cohort study.

OBJECTIVES

This study evaluates the risk for surgical site infections (SSIs) or wound healing problems (WHPs) in patients who underwent corticosteroid injection before lumbar decompression surgery.

SUMMARY OF BACKGROUND DATA

Corticosteroid injections are often used for the treatment of the degenerated spine. However, their well-known immunosuppressive effects could increase the risk for local infections, particularly if a surgical intervention follows the injection rapidly.

METHODS

The Swiss Lumbar Stenosis Outcome Study (LSOS), which is a prospective multicenter cohort study of patients with symptomatic lumbar spinal stenosis, was used as database. Of 743 patients, 422 patients underwent surgery and were eligible for the study. Ten patients (2.4%) were revised for either SSIs (n = 6) or WHPs (n = 4). A control group (n = 19) was constructed matched according to age, sex, diabetes, and body mass index (BMI). Odds ratios (ORs) were calculated by using a conditional logistic regression model to quantify the risk of SSI or WHP after preoperative corticosteroid injection. Subgroup analysis was performed for patients with injection within 0 to 3 months before surgery, 0 to 6 months before surgery, or any injection at all before surgery.

RESULTS

Within this cohort, no significant association could be found between preoperative corticosteroid injection and postoperative SSI or WHP in patients with corticosteroid injections within 0 to 3 months before surgery [OR = 0.36, 95% confidence interval (95% CI) 0.04-3.22], 0 to 6 months before surgery (OR = 0.69 95% CI 0.14-3.49), or any time before surgery (OR = 0.43, 95% CI 0.04-3.22).

CONCLUSION

Within the here investigated cohort, the risk of SSIs or WHPs following lumbar spinal decompression surgery seems not highly associated with preoperative corticosteroid injections. However, the safe time interval between corticosteroid infiltrations and surgery remains unknown, should not be decreased incautiously, and is the subject of further research.

LEVEL OF EVIDENCE

2.

A combined culture-based methodology for surveillance of hospital-acquired infections and timely remedial action in a tertiary care hospital in Delhi, India

The mortality, morbidity and economic loss accompanying hospital acquired infection (HAI) needs constant surveillance. The usefulness of an integrated culture-based watch on the incidence of HAI was established at a tertiary care, multidisciplinary hospital in Delhi. Isolates from all culture-positive hospitalized cases including antibiotic susceptibility profiles were shared instantly with clinicians and nursing personnel. HAI categorization was based on the interval between hospital admission and isolation of a pathogen. The monthly incidence of HAI was calculated as episodes per 100 admissions, while the nature of HAI isolates including infection sites were computed annually. During 2008 to 2010, the monthly HAI rates ranged from 0 to 0.9 per 100 admissions, with no significant difference in annual incidence (P = 0.45, Kruskal Wallis). There was a subtle but insignificant change in HAI localization in urine, blood, pulmonary tissues or surgical sites of the patients (P = 0.104). While 197 of the 229 isolates were Gram-negative, Klebsiella species, E Coli, Pseudomonas aeroginosa, there were 32 methicillin-sensitive Staphylococcus aureus (P < 0.0001). The combined strategy of constant surveillance of all culture-positive hospitalized cases and dialogues with clinicians, and nursing personnel enabled a monitoring of HAI incidence and ensured freedom from any spikes of HAI episodes or their cross infection, it was possible to monitor the incidence of HAI and to ensure there were no episodes on any spikes or a cross-infection. An identical nonstop approach should result in an earlier detection and management of HAI.