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Ultra-short antibiotic prophylaxis guided by preoperative microbiological nasal swabs in endoscopic endonasal skull base surgery
- Source :
- Acta Neurochirurgica. 163:369-382
- Publication Year :
- 2020
- Publisher :
- Springer Science and Business Media LLC, 2020.
-
Abstract
- Endoscopic endonasal skull base surgery (EESBS) is a clean-contaminated procedure. Guidelines regarding the antibiotic prophylaxis in EESBS have not been developed yet, and today, there are no universally accepted protocols. In this article, we investigated the efficacy of our new ultra-short antibiotic prophylaxis protocol for EESBS guided by the cultural results of preoperative microbiological nasal swabs. We defined as “nasal swab-related antibiotic protocol” the administration of a first-generation cephalosporin (cefazolin 2 g) in patients whose nasal swabs revealed the presence of normal nasal flora or methicillin-sensitive Staphylococcus aureus (MSSA), and the administration of vancomycin 1 g intravenously in patients whose nasal swabs revealed the presence of methicillin-resistant Staphylococcus aureus (MRSA) or with reported cephalosporin/penicillin allergy. This case-control study included 120 patients who underwent EESBS. The case group included 60 cases who received the “nasal swab-related antibiotic protocol,” while the control group included 60 cases who received the “standard hospital antibiotic protocol” used in neurosurgery (cefazolin 2 g plus metronidazole 500 mg at induction, and 2 g of cefazolin repeated after 180 min). The preoperative microbiological nasal swabs showed normal nasal flora in 42 patients (70%), MSSA in 17 patients (28.3%), and MRSA in 1 patient (1.6%). During the study period, no cases of meningitis or sinusitis occurred in the case group (“nasal swab-related antibiotic protocol”), while two infections (3.3%, 1 sinusitis and 1 meningitis) were reported in the control group (“standard hospital antibiotic protocol”). Mean length of hospitalization was 6.5 days for the case group and 8.5 days in the control group. “Standard hospital antibiotic protocol” is less expensive (range, 2.88–5.42 euros) compared with our new “nasal swab-related antibiotic protocol” (range, 10.02–32.56 euros), but in line with other antibiotic prophylaxis protocols reported in literature. The low complication rates of our case series (0%) is comparable to complication rates reported in literature (1.6% for meningitis and 8% for sinusitis). Compared with other perioperative antibiotic regimens reported in literature, the “nasal swab-related antibiotic protocol” is cheap and at least equally effective. We discuss the rationale on which we based the choice of chemoprophylaxis, the timing, and the length of our regimen. Our study confirmed the safety and efficacy of our easily applicable and low-cost antibiotic prophylaxis protocol.
- Subjects :
- Adult
Male
Methicillin-Resistant Staphylococcus aureus
medicine.medical_specialty
Adolescent
medicine.drug_class
Antibiotics
Neurosurgery
Cefazolin
Nose
Neurosurgical Procedures
030218 nuclear medicine & medical imaging
Young Adult
03 medical and health sciences
0302 clinical medicine
Vancomycin
Preoperative Care
medicine
Humans
Meningitis
Sinusitis
Antibiotic prophylaxis
Endoscopic surgery
Nasal swabs
Skull base
Transsphenoidal
Aged
Skull Base
business.industry
Endoscopy
Perioperative
Antibiotic Prophylaxis
Middle Aged
Staphylococcal Infections
medicine.disease
Anti-Bacterial Agents
Surgery
Metronidazole
Nasal Swab
Case-Control Studies
Female
Neurology (clinical)
business
030217 neurology & neurosurgery
medicine.drug
Subjects
Details
- ISSN :
- 09420940 and 00016268
- Volume :
- 163
- Database :
- OpenAIRE
- Journal :
- Acta Neurochirurgica
- Accession number :
- edsair.doi.dedup.....02dad4e9a7c0fdddfa3dc1a0d469544f
- Full Text :
- https://doi.org/10.1007/s00701-020-04560-x