The role of antibiotic prophylaxis in the clean neurosurgery

• Published in: World neurosurgery 2017-04, Vol.100, p.305-310
• Main Authors: Cao, YiYao, BS, Pu, Ke, MD, Li, Quodong, BS, Yan, XueJiang, MD, Ma, Yue, MD, Xue, Kai, MD, Sun, ZhiMing, MD, Li, QingGuo, MD
• Format: Article
• Language: English
• Subjects: Adult; Anti-Bacterial Agents - administration & dosage; Antibiotic Prophylaxis - utilization; Antibiotics; Cerebrospinal Fluid Leak - diagnosis; Cerebrospinal Fluid Leak - epidemiology; China - epidemiology; Comorbidity; Female; Humans; Male; Meningitis, Bacterial - epidemiology; Meningitis, Bacterial - microbiology; Meningitis, Bacterial - prevention & control; Neurosurgery; Neurosurgical Procedures - statistics & numerical data; Operative Time; Postoperative infection; Prevalence; Prophylaxis; Retrospective Studies; Risk Factors; Surgical site infection; Surgical Wound Infection - epidemiology; Surgical Wound Infection - microbiology; Surgical Wound Infection - prevention & control; Treatment Outcome
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.12.108

Abstract Objective To investigate the efficacy of antibiotic prophylaxis (AP) and the risk factors for postoperative infections in clean neurosurgery. Methods Data were retrospectively collected on all patients who had undergone clean neurosurgical operation at our institution between January 2009 and December 2014.From January 2009 until October 2011, antibiotic prophylaxis was administered to every clean neurosurgical patient. From November 2011 to December 2014, no antibiotic prophylaxis (n-AP) was prescribed for all clean neurosurgical operations. The efficacy of antibiotic prophylaxis and independent risk factors for infection were studied. Results A total of 808 clean neurosurgical cases were included. The AP group comprised 360 surgical cases, including 29 meningitis cases and 2 cases of incision infections, whereas the n-AP group consisted of 448 surgical cases, including 35 meningitis cases and 4 cases of incision infections(P=0.848).Microorganisms were identified in 7 of 29 cases in the AP group compared to their identification in 22 of 35 cases in the n-AP group (P=0.002).The percentage of patients had multidrug-resistant bacterial meningitis in the AP group was 57.1% compared to 13.6% in the n-AP group (P=0.038).The risk factors for postoperative infection were CSF leakage(OR 27.8; 95% CI: 9.38-28.55) and surgery time(OR: 1.12; 95% CI: 1.02-1.22). Conclusion Our results demonstrate that in our dataset, antibiotic prophylaxis had no preventive effect on postoperative infections in clean neurosurgery. Additionally, AP appeared to decrease the positive bacterial culture rate and to promote the emergence of multidrug-resistant bacteria. CSF leakage and surgery time were the risk factors for postoperative infection.