Summary
Background
Bone flap infections (BFIs) occur following neurosurgical procedures such as craniotomies.
However, they are poorly defined and often not clearly differentiated from other surgical
site infection in neurosurgery.
Aim
To review data from a national adult neurosurgical centre to explore some clinical
aspects to better inform definitions, classification and surveillance methodologies.
Methods
We retrospectively reviewed data on clinical samples sent for culture from patients
with suspected BFI. We also accessed information recorded prospectively from national
and local databases for evidence of BFI or related conditions based on terms used
in surgical operative notes or discharge summaries and documented monomicrobial and
polymicrobial infections related to craniotomy sites.
Findings
Between January 2016 and December 2020, we documented 63 patients with a mean age
of 45 years (16–80). Craniectomy for infection of the skull was the most common terminology
used to describe BFI in the coding used in a national database, 40/63 (63%), but other
terms were used. A malignant neoplasm was the most common underlying condition necessitating
craniectomy in 28/63 (44%) cases. Specimens submitted for microbiological investigation
included 48/63 (76%) bone flaps, 38/63 (60%) fluid/pus, and 29/63 (46%) tissue. Fifty-eight
(92%) patients had at least one culture-positive specimen; 32 (55%) were monomicrobial
and 26 (45%) were polymicrobial. Gram-positive bacteria predominated and Staphylococcus aureus was the most common.
Conclusion
Greater clarity on how to define BFI is required to enable better classification and
the carrying out of appropriate surveillance. This will inform preventative strategies
and more effective patient management.
Keywords
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Article info
Publication history
Published online: March 31, 2023
Accepted:
March 22,
2023
Received:
January 13,
2023
Identification
Copyright
© 2023 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
