2025 Proffered Presentations
S035: INTRAOPERATIVE CULTURES IN ENDOSCOPIC ENDONASAL NEUROSURGICAL CASES SHOW PERSISTENT SURGICAL SITE COLONIZATION WITH PATHOGENIC BACTERIA AFTER PREPARATION WITHOUT POST-OPERATIVE INFECTION
Nataniel J Mandelberg, MD, PhD1; Donato Pacione, MD1; Michael Phillips, MD2; Seth Lieberman, MD3; John G Golfinos, MD1; 1New York University Grossman School of Medicine Department of Neurosurgery; 2New York University Grossman School of Medicine Department of Infectious Disease; 3New York University Grossman School of Medicine Department of Otolaryngology
Introduction: Surgical infections can be devastating in patients undergoing endoscopic endonasal surgery, yet optimal surgical site preparation techniques have not been clearly determined. Furthermore, the profile and origin of pathogens that ultimately go on to cause post-operative infections in these patients remain unclear.
Objectives: Here we sought to determine the effect of surgical site preparation techniques on reducing the presence of potentially pathogenic bacteria at the skull base in patients undergoing endoscopic endonasal surgery.
Methods: This is an ongoing prospective single-center study in which surgical site cultures are taken intranasally before surgical site preparation with betadine, after surgical site preparation, and from the skull base after bony exposure is complete. Here we report the preliminary results for all adult patients enrolled who underwent elective endoscopic endonasal surgery between August 1st and February 29th, 2024. Patients will be followed for up to 90 days post-operatively to identify surgical site infections. All patients received a standard dose of intraoperative cefazolin or vancomycin, and no patients were treated with post-operative antibiotics.
Results: Data was collected from 38 patients undergoing endoscopic endonasal surgery during this period. Patients were 62% female with mean age 52.6±16.9. 33 patients underwent resection of a pituitary adenoma, while 4 underwent resection of skull base meningiomas, 1 repair of a CSF leak, and 1 resection of a chordoma. Pre-preparation cultures were positive in 36 patients. Post-preparation cultures were positive in 30 patients. Cultures obtained from the sphenoid after bony exposure was complete were positive in 22 patients. 7 of these patients had cultures that grew pathogenic bacteria with invasive properties or multi-drug resistance. Pathogens cultured from bone included Staphylococcus lugdunensis, methicillin-sensitive Staphylococcus aureus, and multi-drug resistant Klebsiella aerogenes. Two patients with a positive bone culture had lumbar drains placed intraoperatively, and one patient with a positive bone culture had a lumbar puncture performed post-operative day 3 due to clinical concern for meningitis – cerebrospinal fluid cultures were negative and protein, glucose, and cells counts were within normal limits in all three cases. No patients to date have experienced post-operative infections.
By comparison, we determined infections rates among 846 patients undergoing open cranial or spine surgery at our center to be 1.3%. In these cases, surgical site preparation was with chlorhexidine gluconate (0.9% infection rate) or providone iodine (5.2% infection rate).
Conclusion: Patients undergoing endoscopic endonasal surgery have notable bacteria burdens with potentially pathogenic species at the surgical site even after intraoperative surgical site preparation. This does not correlate immediately with post-operative central nervous system infection, the rate of which is lower than in open cases using a similar preparation agent. As our study continues, we hope to identify optimal intraoperative surgical site preparation techniques and determine whether patients who ultimately develop post-operative infections become infected by pathogens present on intraoperative cultures, or other infectious agents acquired at a different date.