Comparing Rates of Postoperative Meningitis after Endoscopic Endonasal Procedures Based on MRSA/MSSA Colonization and Antibiotic Prophylaxis

Introduction: Due to direct access through the nasopharyngeal mucosa, endoscopic endonasal (EEA) procedures are inherently contaminated. The reported rate of postoperative meningitis in EEA procedures is 0.7 to 3%. There are a variety of approaches to minimize the risk of meningitis with antibiotic prophylaxis, though the only factor consistently correlated with increased risk of meningitis is presence of a cerebrospinal fluid (CSF) leak. This study investigated whether there is a difference in rates of meningitis within 30 days of surgery based on S. aureus colonization and the use of preoperative antibiotic prophylaxis.

Methods: All patients that underwent an EEA resection at our institution from 2013 to 2020 were retrospectively reviewed. Patients who underwent the approach for indications other than tumor resection were excluded. Information including recent preoperative infections, preoperative methicillin-resistant or methicillin-sensitive S. aureus (MRSA/MSSA) colonization status, antibiotic administration including MRSA/MSSA decolonization, and infectious postoperative outcomes were recorded for each patient. All patients received intraoperative antibiotics during the procedure. A Welch two-sample t-test was used to compute statistical significance.

Results: Three hundred eighty-eight patients were identified with a mean age of 52 (range 18–90). Sixty (15.4%) patients had a positive preoperative MRSA/MSSA screening swab. Among those patients, 8 (13.3%) patients were positive for MRSA and 52 (86.7%) patients were positive for MSSA. Eighteen (30.0%) colonized patients were treated with preoperative decolonizing antibiotics. Among those, 16 (88.9%) patients received topical mupirocin and 2 (11.1%) patients received ciprofloxacin. Within 30 days of surgery, 12 (3.1%) patients had culture positive meningitis; 11 (91.7%) cases were bacterial and 1 (8.3%) case was fungal. Of MRSA/MSSA colonized patients, 2 (3.3%) were diagnosed with meningitis. MRSA/MSSA colonized patients did not have a significantly different meningitis risk profile when compared with the rest of the patients and had similar rates of diabetes (p = 0.39), smoking (p = 0.95), and CSF leak (p = 0.66). The distribution of pathologies operated on (adenoma, chordoma, craniopharyngiomas, and meningiomas) was also similar between the two groups. There was no significant difference in the rate of postoperative meningitis based on MRSA/MSSA colonization status (p = 0.91). Among colonized patients, there was no significant difference in rates of postoperative CSF infection (p = 0.08) between those who did and did not receive preoperative antibiotic decolonization.

Conclusion: Preoperative antibiotic prophylaxis for decolonization of MRSA/MSSA is used in some protocols to prevent postoperative meningitis. In this study, postoperative rates of meningitis after EEA surgery were not significantly changed based on MRSA/MSSA colonization status of the patient or antibiotic treatment for preoperative decolonization. The utility of preoperative testing of MRSA/MSSA status and antibiotics for decolonization to prevent postoperative meningitis should be further investigated.

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Artikel online veröffentlicht:
15. Februar 2022