Pathogenesis

PATHOGENESIS OF A NEURO-SURGICAL INFECTION

According to the CDC*  microbial contamination of the surgical site is a necessary precursor of a surgical infection”. Sources of microbial contamination in a neuro-surgical case include surgical instruments (i.e., Kerrison Rongeurs) that are contaminated with dead, sterile bioburden.

When dead, sterile, bioburden gets deposited into the body from a contaminated instrument, the foreign, organic material begins to decompose and is attacked by phagocytes. This process is frequently seen in a post-surgical patient who presents with a fever of unknown origin and an elevated white blood cell count within 24 – 48 hours of surgery.

Phagocytes are the white blood cells that protect the body from harm by ingesting (phagocytosing) harmful foreign particles, including dead, sterile cells. Part of this process involves the production of lysozymes that break down the cell walls of the organic material. Frequently those dead, sterile cell walls contain endotoxins that are then released into the blood stream.

The release of endotoxins in the body stimulates cytokine production. In turn, cytokines can trigger the systemic inflammatory response syndrome that sometimes leads to multiple system organ failure.”

Even more troubling is the fact that when patients died from a surgical infection, “77% of the deaths were reported to be related to the infection,and the majority (93%) were serious infections involving organs or spaces accessed during the operation.”

* Guideline for the Prevention of Surgical Site Infection, 1999, CDC