H Ishihara, S Ishihara, H Neki, M Okawara, R Kanazawa, S Kohyama, F Yamane, S Shibazaki, S Maesaki, G Hashikita
{"title":"神经血管内治疗导致败血症的频率和危险因素。","authors":"H Ishihara, S Ishihara, H Neki, M Okawara, R Kanazawa, S Kohyama, F Yamane, S Shibazaki, S Maesaki, G Hashikita","doi":"10.1055/s-0030-1268414","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Endovascular treatments are minimally invasive and rarely cause complicating infections. Although cases complicated by device infections have been reported, we could not find any studies evaluating infections following neuroendovascular treatment in particular. Therefore, we assessed the frequency of sepsis and other associated risk factors.</p><p><strong>Methods: </strong>From September 2006 to May 2008, we investigated 256 prospective neuroendovascular treatment cases at our facility. We examined the frequency of sepsis and other associated risk factors as well as organisms and the early detection tests such as various cultures and serodiagnoses.</p><p><strong>Results: </strong>The rate of sepsis due to complications was 8.6% in the aggregate and 5.7% in 193 procedures without a central venous catheter and hemodialysis. All sepsis cases were successfully treated with antibiotics. However, in 2 cases, the patients developed methicillin-resistant STAPHYLOCOCCUS AUREUS infections, which were intractable. The highest risk factors for sepsis were a large sheath size [>7 F; OR =5.03; P =0.01; 95% confidence interval (CI) 1.29-19.47] and meningioma embolization (OR =13.25; P =0.04; 95% CI 1.07-163.56). The degree to which experienced staff (OR =0.09; P =0.05; 95% CI 0.09-0.97) affected the incidence of sepsis was less significant. Microorganisms were isolated from half the operating field, and the risk factor, in this case, depended on inexperienced surgical staff (OR =1.98; P =0.03; 95% CI 1.07-3.67). Although we were unable to find a means to predict sepsis, we presumed antibiotic prophylaxis would be useful.</p><p><strong>Conclusions: </strong>The frequency of sepsis following neuroendovascular treatment is high. We should pay particular attention to the sterilization process and the operating field when undertaking neuroendovascular treatment that requires the use of a large-size sheath in patients with serious conditions.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2010-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1268414","citationCount":"2","resultStr":"{\"title\":\"Frequency and risk factors for sepsis resulting from neuroendovascular treatment.\",\"authors\":\"H Ishihara, S Ishihara, H Neki, M Okawara, R Kanazawa, S Kohyama, F Yamane, S Shibazaki, S Maesaki, G Hashikita\",\"doi\":\"10.1055/s-0030-1268414\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Endovascular treatments are minimally invasive and rarely cause complicating infections. Although cases complicated by device infections have been reported, we could not find any studies evaluating infections following neuroendovascular treatment in particular. Therefore, we assessed the frequency of sepsis and other associated risk factors.</p><p><strong>Methods: </strong>From September 2006 to May 2008, we investigated 256 prospective neuroendovascular treatment cases at our facility. We examined the frequency of sepsis and other associated risk factors as well as organisms and the early detection tests such as various cultures and serodiagnoses.</p><p><strong>Results: </strong>The rate of sepsis due to complications was 8.6% in the aggregate and 5.7% in 193 procedures without a central venous catheter and hemodialysis. All sepsis cases were successfully treated with antibiotics. However, in 2 cases, the patients developed methicillin-resistant STAPHYLOCOCCUS AUREUS infections, which were intractable. The highest risk factors for sepsis were a large sheath size [>7 F; OR =5.03; P =0.01; 95% confidence interval (CI) 1.29-19.47] and meningioma embolization (OR =13.25; P =0.04; 95% CI 1.07-163.56). The degree to which experienced staff (OR =0.09; P =0.05; 95% CI 0.09-0.97) affected the incidence of sepsis was less significant. Microorganisms were isolated from half the operating field, and the risk factor, in this case, depended on inexperienced surgical staff (OR =1.98; P =0.03; 95% CI 1.07-3.67). Although we were unable to find a means to predict sepsis, we presumed antibiotic prophylaxis would be useful.</p><p><strong>Conclusions: </strong>The frequency of sepsis following neuroendovascular treatment is high. We should pay particular attention to the sterilization process and the operating field when undertaking neuroendovascular treatment that requires the use of a large-size sheath in patients with serious conditions.</p>\",\"PeriodicalId\":49808,\"journal\":{\"name\":\"Minimally Invasive Neurosurgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2010-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1055/s-0030-1268414\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Minimally Invasive Neurosurgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1055/s-0030-1268414\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2011/2/7 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Minimally Invasive Neurosurgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1055/s-0030-1268414","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2011/2/7 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 2
摘要
目的:血管内治疗具有微创性,很少引起并发症。虽然有病例合并器械感染的报道,但我们没有发现任何评估神经血管内治疗后感染的研究。因此,我们评估了脓毒症的发生频率和其他相关危险因素。方法:从2006年9月到2008年5月,我们调查了256例神经血管内治疗的患者。我们检查了脓毒症的频率和其他相关的危险因素,以及微生物和早期检测测试,如各种培养和血清诊断。结果:在193例无中心静脉导管和血液透析的手术中,并发症引起的脓毒症发生率为8.6%,5.7%。所有败血症病例均成功应用抗生素治疗。但2例患者发生耐甲氧西林金黄色葡萄球菌感染,难治性。脓毒症的最高危险因素是鞘大[>7 F];或= 5.03;P = 0.01;95%可信区间(CI) 1.29-19.47)和脑膜瘤栓塞(OR =13.25;P = 0.04;95% ci 1.07-163.56)。经验丰富的员工(OR =0.09;P = 0.05;95% CI 0.09-0.97)对脓毒症发生率的影响较小。一半的手术区域分离出微生物,在这种情况下,危险因素取决于缺乏经验的手术人员(OR =1.98;P = 0.03;95% ci 1.07-3.67)。虽然我们无法找到预测败血症的方法,但我们认为抗生素预防是有用的。结论:神经血管内治疗后脓毒症发生率高。在对病情严重的患者进行需要使用大尺寸鞘的神经血管内治疗时,应特别注意灭菌过程和手术范围。
Frequency and risk factors for sepsis resulting from neuroendovascular treatment.
Objective: Endovascular treatments are minimally invasive and rarely cause complicating infections. Although cases complicated by device infections have been reported, we could not find any studies evaluating infections following neuroendovascular treatment in particular. Therefore, we assessed the frequency of sepsis and other associated risk factors.
Methods: From September 2006 to May 2008, we investigated 256 prospective neuroendovascular treatment cases at our facility. We examined the frequency of sepsis and other associated risk factors as well as organisms and the early detection tests such as various cultures and serodiagnoses.
Results: The rate of sepsis due to complications was 8.6% in the aggregate and 5.7% in 193 procedures without a central venous catheter and hemodialysis. All sepsis cases were successfully treated with antibiotics. However, in 2 cases, the patients developed methicillin-resistant STAPHYLOCOCCUS AUREUS infections, which were intractable. The highest risk factors for sepsis were a large sheath size [>7 F; OR =5.03; P =0.01; 95% confidence interval (CI) 1.29-19.47] and meningioma embolization (OR =13.25; P =0.04; 95% CI 1.07-163.56). The degree to which experienced staff (OR =0.09; P =0.05; 95% CI 0.09-0.97) affected the incidence of sepsis was less significant. Microorganisms were isolated from half the operating field, and the risk factor, in this case, depended on inexperienced surgical staff (OR =1.98; P =0.03; 95% CI 1.07-3.67). Although we were unable to find a means to predict sepsis, we presumed antibiotic prophylaxis would be useful.
Conclusions: The frequency of sepsis following neuroendovascular treatment is high. We should pay particular attention to the sterilization process and the operating field when undertaking neuroendovascular treatment that requires the use of a large-size sheath in patients with serious conditions.