Clinical, radiological, and microbiological profile of patients with autogenous cranioplasty infections

I.P. Bhaskar, Tim Inglis, Gabriel Lee

    Research output: Contribution to journalArticle

    11 Citations (Scopus)

    Abstract

    © 2014 Elsevier Inc. Objective: Bone flap infections after autogenous cranioplasty can present a diagnostic and management challenge. Little is known about the clinical, radiological, and microbiological profile of these patients. Methods: Patients who developed bone flap infective complications requiring explantation after autogenous cranioplasties between 1999 and 2009 were identified. Their prospectively collected demographic details, clinical presentation, radiological features, surgical intervention, microbiological profile, and treatment outcomes were retrospectively reviewed. Results: During the study period, 179 cranioplasties were performed with frozen autogenous skull flaps. Seventeen patients (10%, median age 25 years) experienced deep infections that necessitated flap removal and antimicrobial treatment. Although fever, swelling of the scalp, and local inflammation were present in majority of patients (76.5%), inflammatory markers were abnormal only in 33%. Computed tomography imaging features included extra-axial collection (76.5%), subgaleal collection or galeal swelling (70.6%), cerebritis (37.5%), and osteomyelitis (23.5%). Positive bacterial cultures were obtained from all (100%) explanted bone flaps, including gram-positive (82.3 %) and -negative (17.7%) organisms. A significant proportion (29.4%) of patients presented with complications late during follow-up (>6 weeks); 60% of these were attributable to Propionibacterium acnes infection. Conclusions: Clinical assessment is critical to the diagnosis of bone-flap infection. A high index of suspicion is necessary because late presentations are possible. Empirical antimicrobial treatment should include gram-negative coverage.
    Original languageEnglish
    Pages (from-to)E531-E534
    JournalWorld Neurosurgery
    Volume82
    Issue number3
    DOIs
    Publication statusPublished - 2014

    Fingerprint

    Bone and Bones
    Infection
    Propionibacterium acnes
    Osteomyelitis
    Scalp
    Skull
    Fever
    Tomography
    Demography
    Inflammation
    Therapeutics

    Cite this

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    title = "Clinical, radiological, and microbiological profile of patients with autogenous cranioplasty infections",
    abstract = "{\circledC} 2014 Elsevier Inc. Objective: Bone flap infections after autogenous cranioplasty can present a diagnostic and management challenge. Little is known about the clinical, radiological, and microbiological profile of these patients. Methods: Patients who developed bone flap infective complications requiring explantation after autogenous cranioplasties between 1999 and 2009 were identified. Their prospectively collected demographic details, clinical presentation, radiological features, surgical intervention, microbiological profile, and treatment outcomes were retrospectively reviewed. Results: During the study period, 179 cranioplasties were performed with frozen autogenous skull flaps. Seventeen patients (10{\%}, median age 25 years) experienced deep infections that necessitated flap removal and antimicrobial treatment. Although fever, swelling of the scalp, and local inflammation were present in majority of patients (76.5{\%}), inflammatory markers were abnormal only in 33{\%}. Computed tomography imaging features included extra-axial collection (76.5{\%}), subgaleal collection or galeal swelling (70.6{\%}), cerebritis (37.5{\%}), and osteomyelitis (23.5{\%}). Positive bacterial cultures were obtained from all (100{\%}) explanted bone flaps, including gram-positive (82.3 {\%}) and -negative (17.7{\%}) organisms. A significant proportion (29.4{\%}) of patients presented with complications late during follow-up (>6 weeks); 60{\%} of these were attributable to Propionibacterium acnes infection. Conclusions: Clinical assessment is critical to the diagnosis of bone-flap infection. A high index of suspicion is necessary because late presentations are possible. Empirical antimicrobial treatment should include gram-negative coverage.",
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    Clinical, radiological, and microbiological profile of patients with autogenous cranioplasty infections. / Bhaskar, I.P.; Inglis, Tim; Lee, Gabriel.

    In: World Neurosurgery, Vol. 82, No. 3, 2014, p. E531-E534.

    Research output: Contribution to journalArticle

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    AU - Lee, Gabriel

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    N2 - © 2014 Elsevier Inc. Objective: Bone flap infections after autogenous cranioplasty can present a diagnostic and management challenge. Little is known about the clinical, radiological, and microbiological profile of these patients. Methods: Patients who developed bone flap infective complications requiring explantation after autogenous cranioplasties between 1999 and 2009 were identified. Their prospectively collected demographic details, clinical presentation, radiological features, surgical intervention, microbiological profile, and treatment outcomes were retrospectively reviewed. Results: During the study period, 179 cranioplasties were performed with frozen autogenous skull flaps. Seventeen patients (10%, median age 25 years) experienced deep infections that necessitated flap removal and antimicrobial treatment. Although fever, swelling of the scalp, and local inflammation were present in majority of patients (76.5%), inflammatory markers were abnormal only in 33%. Computed tomography imaging features included extra-axial collection (76.5%), subgaleal collection or galeal swelling (70.6%), cerebritis (37.5%), and osteomyelitis (23.5%). Positive bacterial cultures were obtained from all (100%) explanted bone flaps, including gram-positive (82.3 %) and -negative (17.7%) organisms. A significant proportion (29.4%) of patients presented with complications late during follow-up (>6 weeks); 60% of these were attributable to Propionibacterium acnes infection. Conclusions: Clinical assessment is critical to the diagnosis of bone-flap infection. A high index of suspicion is necessary because late presentations are possible. Empirical antimicrobial treatment should include gram-negative coverage.

    AB - © 2014 Elsevier Inc. Objective: Bone flap infections after autogenous cranioplasty can present a diagnostic and management challenge. Little is known about the clinical, radiological, and microbiological profile of these patients. Methods: Patients who developed bone flap infective complications requiring explantation after autogenous cranioplasties between 1999 and 2009 were identified. Their prospectively collected demographic details, clinical presentation, radiological features, surgical intervention, microbiological profile, and treatment outcomes were retrospectively reviewed. Results: During the study period, 179 cranioplasties were performed with frozen autogenous skull flaps. Seventeen patients (10%, median age 25 years) experienced deep infections that necessitated flap removal and antimicrobial treatment. Although fever, swelling of the scalp, and local inflammation were present in majority of patients (76.5%), inflammatory markers were abnormal only in 33%. Computed tomography imaging features included extra-axial collection (76.5%), subgaleal collection or galeal swelling (70.6%), cerebritis (37.5%), and osteomyelitis (23.5%). Positive bacterial cultures were obtained from all (100%) explanted bone flaps, including gram-positive (82.3 %) and -negative (17.7%) organisms. A significant proportion (29.4%) of patients presented with complications late during follow-up (>6 weeks); 60% of these were attributable to Propionibacterium acnes infection. Conclusions: Clinical assessment is critical to the diagnosis of bone-flap infection. A high index of suspicion is necessary because late presentations are possible. Empirical antimicrobial treatment should include gram-negative coverage.

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