Severe surgical site infections following cochlear implant surgery

Objective This study aimed to describe epidemiology and management of severe surgical site infections (SSIs) following cochlear implantation (CI) and to identify risk factors.Methods A retrospective monocentric study of all CI procedures was performed at our tertiary referral centre between January 2018 and December 2023. Data on patient demographics, clinical features and postoperative infections were collected. Severe SSIs were defined as abscess, skin flap necrosis or device extrusion requiring hospitalisation and/or IV antibiotics. Univariate and multivariate analyses were performed to identify risk factors.Results Of the 383 CIs, 3.6% (n = 14) developed severe SSIs. A salvage surgery was attempted in 85.7% of cases and the device explantation rate was of 71.4%. Staphylococcus aureus and Pseudomonas aeruginosa were the most identified pathogens. Chronic otorrhea was identified as a statistically significant risk factor for severe SSI (p < 0.001). No significant associations were found with obesity, tobacco use, diabetes, bilateral implantation or implantation renewal.Conclusions Severe SSIs following CI are rare but challenging to treat, with a poor outcome. Chronic otorrhea appears to be a significant risk factor. Early intervention with IV antibiotics followed by salvage surgery may help avoid explantation.