Risk factors and clinical characteristics of postoperative ESKAPE infections following endoscopic endonasal surgery

To investigate the risk factors associated with postoperative ESKAPE infections in patients undergoing Endoscopic Endonasal surgery, aiming to provide insights into reducing the incidence and mortality of such infections. A retrospective analysis was conducted on 1,035 patients who underwent Endoscopic Endonasal surgery in The First Affiliated Hospital of Nanchang University between March 2018 and March 2025. Univariate analysis and multivariate logistic regression were performed to identify risk factors associated with postoperative ESKAPE infections. A total of 20 patients (1.93%) developed postoperative ESKAPE infections, among whom 11 died, resulting in a postoperative mortality rate of 1.06% and a fatality rate of 55% among infected patients. Univariate analysis revealed significant associations between ESKAPE infection and, history of prior craniotomy or transnasal surgery (P = 0.04), impaired consciousness (GCS ≤ 8) (P = 0.02), intraoperative blood loss > 400 mL (P = 0.03), History of lumbar puncture(P = 0.05) and postoperative CSF leakage (P < 0.001). Multivariate logistic regression identified the following independent risk factors: Postoperative GCS ≤ 8 (OR = 6.62; 95% CI: 1.09–46.3;p < 0.05), intraoperative blood loss > 400 mL (OR = 4.92; 95% CI: 1.45–18.3;p < 0.05), BMI ≥ 25 or BMI < 18.5 (OR = 3.84; 95% CI: 1.09–14.7;p < 0.05)and postoperative CSF leakage (OR = 6.78; 95% CI: 1.69–30.3;p < 0.01). The incidence of ESKAPE infection after Endoscopic Endonasal surgery is low, but the fatality rate remains high once infection occurs. The major potential risk factors include abnormal BMI (≥ 25 or < 18.5), intraoperative blood loss > 400 mL, impaired consciousness (GCS ≤ 8), and postoperative CSF leakage.