A Comparative Evaluation of Risk Factors and Various Antibiotic Regimens in Postoperative Neurosurgical Infections: A Prospective Randomized Controlled Study
21 November 2015
18 January 2016
03 October 2017 (online)
Introduction Postoperative neurosurgical infections are a major problem, and the importance of keeping them to an absolute minimum cannot but be overemphasized. In this prospective study, we plan to evaluate the efficacy of three antibiotic regimens designed keeping the availability, affordability, and efficacy upon the common bacterial flora isolated at our center. We will also analyze the incidence and evaluate the risk factors of surgical site infections following clean, nonimplant, fresh, elective craniotomies.
Material and Methods This prospective randomized control study was conducted at our institute, a tertiary referral center, for a period of 2 years. The study cohort included all patients undergoing clean, nonimplant, fresh, elective craniotomies at our institute. The antibiotic protocol was chosen according to the current bacterio-epidemiological data based on the prevalence of infectious agent. One of the three drug regimens was chosen.
Results The results of univariate analysis revealed that there are multiple factors that are significantly associated with postoperative surgical site infection. In the multivariate analysis, only the presence of cerebrospinal fluid leak was the most significant factor associated with postoperative infections. Among the three different antibiotic regimens, cefazolin and amoxicillin–clavulanic acid were much better prophylactic agents for preventing surgical site infections when compared with cefotaxime.
Conclusion The present study has provided an insight into the incidence and risk factors contributing to surgical site infections as well as the efficacious antibiotic regimen protocols. The present study is one of the few studies to compare the efficacy of different antibiotic regimen protocols and also prospectively analyze the factors contributing to postoperative infections. This study will help us in optimizing the prophylaxis protocols and prevent emergence of multidrug-resistant strains, especially in a country like India.
- 1 Korinek AM, Golmard JL, Elcheick A. , et al. Risk factors for neurosurgical site infections after craniotomy: a critical reappraisal of antibiotic prophylaxis on 4,578 patients. Br J Neurosurg 2005; 19 (02) 155-162
- 2 Korinek AM, Baugnon T, Golmard JL, van Effenterre R, Coriat P, Puybasset L. Risk factors for adult nosocomial meningitis after craniotomy: role of antibiotic prophylaxis. Neurosurgery 2006; 59 (01) 126-133 , discussion 126–133
- 3 Srinivas D, Veena Kumari HB, Somanna S, Bhagavatula I, Anandappa CB. The incidence of postoperative meningitis in neurosurgery: an institutional experience. Neurol India 2011; 59 (02) 195-198
- 4 Sharma MS, Vohra A, Thomas P. , et al. Effect of risk-stratified, protocol-based perioperative chemoprophylaxis on nosocomial infection rates in a series of 31 927 consecutive neurosurgical procedures (1994-2006). Neurosurgery 2009; 64 (06) 1123-1130 , discussion 1130–1131
- 5 Arunodaya GR. Infections in neurology and neurosurgery intensive care units. Neurol India 2001; 49 (Suppl. 01) S51-S59
- 6 Barker II FG. Efficacy of prophylactic antibiotics against meningitis after craniotomy: a meta-analysis. Neurosurgery 2007; 60 (05) 887-894 , discussion 887–894
- 7 Gulati S, Kapil A, Das B, Dwivedi SN, Mahapatra AK. Nosocomial infections due to Acinetobacter baumannii in a neurosurgery ICU. Neurol India 2001; 49 (02) 134-137
- 8 Patir R, Mahapatra AK, Banerji AK. Risk factors in postoperative neurosurgical infection. A prospective study. Acta Neurochir (Wien) 1992; 119 (1–4): 80-84
- 9 Balch RE. Wound infections complicating neurosurgical procedures. J Neurosurg 1967; 26 (01) 41-45
- 10 Wright RL. A survey of possible etiologic agents in postoperative craniotomy infections. J Neurosurg 1966; 25 (02) 125-132
- 11 Williams REO, McDonald JC, Blowere R. Incidence of wound infection in England and Wales: a report of the public health laboratory service. Lancet 1960; 2: 659-663
- 12 Forbes GB. Staphylococal infection of operation wounds with special reference to topical antibiotic prophylaxis. Lancet 1961; 2 (7201): 505-509
- 13 Mahapatra AK, Banerji AK, Bhatia R, Tandon PN. Prevalence of infection among neurosurgical patients: a prospective study of 507 operated patients. Neurol India 1989; 37: 229-237
- 14 Valentini LG, Casali C, Chatenoud L, Chiaffarino F, Uberti-Foppa C, Broggi G. Surgical site infections after elective neurosurgery: a survey of 1747 patients. Neurosurgery 2008; 62 (01) 88-95 , discussion 95–96
- 15 Reichert MC, Medeiros EA, Ferraz FA. Hospital-acquired meningitis in patients undergoing craniotomy: incidence, evolution, and risk factors. Am J Infect Control 2002; 30 (03) 158-164
- 16 van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004; 351 (18) 1849-1859
- 17 Minchew BH, Cluff LE. Studies of the epidemiology of staphylococcal infection. I. Infection in hospitalized patients. J Chronic Dis 1961; 13: 354-373
- 18 Mollman HD, Haines SJ. Risk factors for postoperative neurosurgical wound infection. A case-control study. J Neurosurg 1986; 64 (06) 902-906
- 19 Moiyadi AV, Sumukhi U, Shetty PM, Biswas S, Kelkar RS. Scalp flora in Indian patients undergoing craniotomy for brain tumors - Implications for pre-surgical site preparation and surgical site infection. Indian J Neurosurg 2012; 1: 28-32
- 20 Tokimura H, Tajitsu K, Tsuchiya M. , et al. Cranial surgery without head shaving. J Craniomaxillofac Surg 2009; 37 (08) 477-480
- 21 Pryor F, Messmer PR. The effect of traffic patterns in the OR on surgical site infections. AORN J 1998; 68 (04) 649-660
- 22 Erman T, Demirhindi H, Göçer AI, Tuna M, Ildan F, Boyar B. Risk factors for surgical site infections in neurosurgery patients with antibiotic prophylaxis. Surg Neurol 2005; 63 (02) 107-112 , discussion 112–113