一般開頭術におけるSSI

Surgical Site Infection Following Craniotomies

Point

・術後30日以内の創部を巻き込む感染を手術部位感染（SSI）と呼ぶ．

・開頭術後のSSI発生率は2〜8%程度である．

・深部SSIでは広域抗菌薬使用を視野に入れ，感染箇所・形態把握，原因菌同定，感染源の外科的除去，長期抗菌薬加療が治療の中核となる．

・SSI低減に向けてリスク因子を理解し，evidence-basedな取り組みを行っていくことが肝要である．

　Surgical site infections（SSIs）remain a significant complication of craniotomies, with a reported incidence ranging from 1% to 8%. SSIs are generally categorized as superficial, deep incisional, and organ/space SSIs. Computed tomography and/or magnetic resonance imaging are essential for determining the depth of infection. Lumbar puncture is also helpful for the diagnosis of meningitis; however, imaging studies should be performed prior lumbar puncture to minimize the risk of cerebral herniation. While superficial SSIs can be resolved with antibiotics, all deeper SSIs except meningitis generally require surgical interventions, including wound wash-out and debridement of necrotic tissues and artificial materials, followed by 6-8 weeks of medical treatment using broad-spectrum antibiotics. Administration of antibiotics may be deferred until the specimens are corrected to increase the detection rate of causative microorganisms. Various factors are known to be associated with SSIs; thus, evidence-based efforts should be made to decrease the incidence of SSIs.