Antibiotic Use in Lateral Skull Base Surgery: A Survey of the North American Skull Base Society

Abstract

Objectives Antibiotic use in lateral skull base surgery (LSBS) has not been thoroughly investigated in the literature. There is wide variability in antibiotic use and insufficient data to guide management. This study aims to describe the factors and patterns influencing antibiotic use in LSBS among the membership of the North American Skull Base Society (NASBS).

Design An online-based survey was designed and distributed to the membership of the NASBS. Data was analyzed using bivariate analysis and logistic regression modeling.

Setting Online-based questionnaire.

Participants NASBS membership.

Main Outcome Measures Use of intraoperative antibiotics and use of postoperative antibiotics.

Results The survey response rate was 26% (208 respondents). Of the 208 total respondents, 143 (69%) respondents performed LSBS. Most respondents are neurosurgeons (69%) with the remaining being otolaryngologists (31%). The majority of respondents (79%) are fellowship-trained in skull base surgery. Academic or government physicians make up 69% of respondents and 31% are in private practice with or without academic affiliations. Bivariate analysis showed that practice setting significantly influenced intraoperative antibiotic use (p = 0.01). Geographic location significantly affected postoperative antibiotic use (p = 0.01). Postoperative antibiotic duration was significantly affected by presence of chronic otitis media, cerebrospinal fluid leak, and surgeon training (p = 0.02, p = 0.01, and p = 0.006, respectively). Logistic regression modeling showed that the motivation to reduce infection significantly impacted postoperative antibiotic use (p = 0.03).

Conclusion This study demonstrates significant variations in intraoperative and postoperative antibiotic use in LSBS among the NASBS membership. Appropriate guidelines for optimal perioperative antibiotic use patterns should be determined with randomized studies in the future.

Keywords

lateral skull base - skull base - antibiotics - prophylaxis - intraoperative - postoperative - North American Skull Base Society - NASBS

Publikationsverlauf

Eingereicht: 29. Juni 2020

Angenommen: 16. Oktober 2020

Artikel online veröffentlicht:
04. Februar 2021

• References

• 1 Patel PN, Jayawardena ADL, Walden RL, Penn EB, Francis DO. Evidence-based use of perioperative antibiotics in otolaryngology. Otolaryngol Head Neck Surg 2018; 158 (05) 783-800
• 2 Darrouzet V, Martel J, Enée V, Bébéar JP, Guérin J. Vestibular schwannoma surgery outcomes: our multidisciplinary experience in 400 cases over 17 years. Laryngoscope 2004; 114 (04) 681-688
• 3 Sanna M, Taibah A, Russo A, Falcioni M, Agarwal M. Perioperative complications in acoustic neuroma (vestibular schwannoma) surgery. Otol Neurotol 2004; 25 (03) 379-386
• 4 Slattery III WH, Francis S, House KC. Perioperative morbidity of acoustic neuroma surgery. Otol Neurotol 2001; 22 (06) 895-902
• 5 Stevens SM, Smith CJ, Lawton M. Postoperative management of patients with spontaneous cerebrospinal fluid leak. Curr Opin Otolaryngol Head Neck Surg 2019; 27 (05) 361-368
• 6 Bratzler DW, Dellinger EP, Olsen KM. et al; American Society of Health-System Pharmacists (ASHP), Infectious Diseases Society of America (IDSA), Surgical Infection Society (SIS), Society for Healthcare Epidemiology of America (SHEA). Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14 (01) 73-156
• 7 Savitz SI, Rivlin MM, Savitz MH. The ethics of prophylactic antibiotics for neurosurgical procedures. J Med Ethics 2002; 28 (06) 358-363
• 8 Valdez TA, Marvin K, Bennett NJ, Lerer T, Nolder AR, Buchinsky FJ. Current trends in perioperative antibiotic use: a survey of otolaryngologists. Otolaryngol Head Neck Surg 2015; 152 (01) 63-66
• 9 Laxminarayan R, Duse A, Wattal C. et al. Antibiotic resistance-the need for global solutions. Lancet Infect Dis 2013; 13 (12) 1057-1098
• 10 Fang CH, Hawn VS, Agarwal V. et al. Antibiotic prophylaxis in anterior skull-base surgery: a survey of the North American Skull Base Society. Int Forum Allergy Rhinol 2019; 9 (10) 1196-1204
• 11 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
• 12 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
• 13 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 2008; 62 (Suppl. 02) 532-539
• 14 Alotaibi AF, Hulou MM, Vestal M. et al. The efficacy of antibacterial prophylaxis against the development of meningitis after craniotomy: a meta-analysis. World Neurosurg 2016; 90: 597-603.e1
• 15 Barker II FG. Efficacy of prophylactic antibiotics against meningitis after craniotomy: a meta-analysis. Neurosurgery 2007; 60 (05) 887-894 , discussion 887–894
• 16 Dykema J, Jones NR, Piché T, Stevenson J. Surveying clinicians by web: current issues in design and administration. Eval Health Prof 2013; 36 (03) 352-381
• 17 Cho YI, Johnson TP, Vangeest JB. Enhancing surveys of health care professionals: a meta-analysis of techniques to improve response. Eval Health Prof 2013; 36 (03) 382-407
• 18 Patnaik U, Panda S, Thakar A. Audit of complications in an otolaryngology led skull-base surgical practice. J Neurol Surg B Skull Base 2019; 80 (06) 586-592
• 19 Welling DB, Thomas R, Slater P, Daniels RL, Goodman JH. Preoperative antibiotics and steroids in vestibular schwannoma excision. Laryngoscope 1999; 109 (7 Pt 1): 1081-1083
• 20 Marshall WF, Blair JE. The cephalosporins. Mayo Clin Proc 1999; 74 (02) 187-195
• 21 van Ek B, Dijkmans BA, van Dulken H, Mouton RP, Hermans J, van Furth R. Effect of cloxacillin prophylaxis on the bacterial flora of craniotomy wounds. Scand J Infect Dis 1990; 22 (03) 345-352
• 22 van Ek B, Dijkmans BA, van Dulken H, van Furth R. Antibiotic prophylaxis in craniotomy: a prospective double-blind placebo-controlled study. Scand J Infect Dis 1988; 20 (06) 633-639
• 23 Pulcini C. Antibiotic stewardship: a European perspective. FEMS Microbiol Lett 2017;364(23)
• 24 Kraus DH, Gonen M, Mener D, Brown AE, Bilsky MH, Shah JP. A standardized regimen of antibiotics prevents infectious complications in skull base surgery. Laryngoscope 2005; 115 (08) 1347-1357
• 25 Tsitsopoulos PP, Iosifidis E, Antachopoulos C. et al. Nosocomial bloodstream infections in neurosurgery: a 10-year analysis in a center with high antimicrobial drug-resistance prevalence. Acta Neurochir (Wien) 2016; 158 (09) 1647-1654
• 26 Wang X, Wu P, Huang H, Fu M, Ge R. Analyses of chronic otitis media with intact tympanic membrane concurrent with intracranial complication [in Chinese]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2016; 51 (05) 343-347
• 27 Greenberg JS, Manolidis S. High incidence of complications encountered in chronic otitis media surgery in a U.S. metropolitan public hospital. Otolaryngol Head Neck Surg 2001; 125 (06) 623-627
• 28 Prasad SC, Shin SH, Russo A, Di Trapani G, Sanna M. Current trends in the management of the complications of chronic otitis media with cholesteatoma. Curr Opin Otolaryngol Head Neck Surg 2013; 21 (05) 446-454
• 29 Horowitz G, Fliss DM, Margalit N, Wasserzug O, Gil Z. Association between cerebrospinal fluid leak and meningitis after skull base surgery. Otolaryngol Head Neck Surg 2011; 145 (04) 689-693