Surgical site infections with multi-drug resistant organisms in patients undergoing neurosurgery: a retrospective comparative cohort study from Turkey.

Background: Multidrug-resistant organisms (MDROs) are a growing global health threat, contributing to higher morbidity and mortality, particularly for surgical site infections (SSIs). This study investigates the risk factors and outcomes of SSIs caused by MDROs in patients undergoing neurosurgery.

Methods: This study was a retrospective comparative study which included 202 patients that had SSIs after neurosurgical procedures between 2014 and 2024 in Turkey. Patients were divided into two groups according to results of wound culture: MDRO and non-MDRO groups. Binary logistic regression was used to identify independent risk factors for MDRO-related SSIs.

Results: The MDRO group (n = 60) had significantly higher all-cause mortality (28.3% vs. 8.5%, p <0.01), ICU admission (81.7% vs. 57%, p = 0.01), and longer hospital stays (30 days vs. 24 days, p = 0.04) compared to the non-MDRO group (n = 142). Emergency surgeries, American Society of Anesthesiologists (ASA) grade ≥3, corticosteroid use and organ/space SSIs were identified as significant risk factors. Logistic regression analysis revealed that only organ/space SSIs were independently associated with MDRO-related SSIs (p <0.01).

Conclusion: This study highlights the significance of MDRO-related SSIs in neurosurgery by demonstrating worse clinical outcomes, including higher mortality, prolonged hospital stays, and increased ICU admission rates. By identifying key risk factors, it contributes to the management of SSIs and supports the development of targeted prevention and control strategies in neurosurgical settings. These findings underscore the need for enhanced infection control measures and may inform future clinical guidelines and research aimed at reducing the burden of MDRO infections in neurosurgical patients.