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27.07.2020 | Original Article - Infection

Reduction in the infection rate of cranioplasty with a tailored antibiotic prophylaxis: a nonrandomized study

verfasst von: Igor Paredes, Alfonso Lagares, Rafael San-Juan, Ana María Castaño-León, Pedro-Antonio Gómez, Luis Jimenez-Roldán, Irene Panero, Carla Eiriz, Daniel García-Perez, Luis Miguel Moreno, Angel Perez-Nuñez, Pedro Gonzalez-León, José Antonio F. Alén

Erschienen in: Acta Neurochirurgica | Ausgabe 11/2020

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Abstract

Background

Cranioplasty carries a high risk of surgical site infections (SSIs) for a scheduled procedure, particularly with antibiotic-resistant bacteria.

Methods

The goal of this retrospective study was to measure the effect of tailored antibiotic prophylaxis on SSIs resulting from cranioplasties. The authors collected a prospective database of cranioplasties from 2009 to 2018. Risk factors for SSI were registered, as well as infection occurring during the first year postoperatively. A new protocol was initiated in 2016 consisting of antibiotic prophylaxis tailored to the colonizing flora of the skin of the scalp and decolonization of patients who were nasal carriers of methicillin-resistant S. aureus (MRSA); infection rates were compared.

Results

One hundred nine cranioplasties were identified, 64 in the old protocol and 45 in the new protocol. Of the 109 cranioplasties, 16 (14.7%) suffered an infection, 14 (21.9%) in the old protocol group and 2 (4.4%) in the new protocol group (OR for the new protocol 0.166, 95% CI 0.036–0.772). Multiple surgeries (OR 3.44), Barthel ≤ 70 (OR 3.53), and previous infection (OR 3.9) were risk factors for SSI. Of the bacteria identified in the skin of the scalp, 22.2% were resistant to routine prophylaxis (cefazoline). Only one patient was identified as a nasal carrier of MRSA and was decolonized.

Conclusions

A high percentage of bacteria resistant to routine prophylaxis (cefazoline) was identified in the skin of these patients’ scalps. The use of tailored antibiotic prophylaxis reduced significantly the infection rate in this particular set of patients.

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Titel: Reduction in the infection rate of cranioplasty with a tailored antibiotic prophylaxis: a nonrandomized study
verfasst von: Igor Paredes
Alfonso Lagares
Rafael San-Juan
Ana María Castaño-León
Pedro-Antonio Gómez
Luis Jimenez-Roldán
Irene Panero
Carla Eiriz
Daniel García-Perez
Luis Miguel Moreno
Angel Perez-Nuñez
Pedro Gonzalez-León
José Antonio F. Alén
Publikationsdatum: 27.07.2020
Verlag: Springer Vienna
Erschienen in: Acta Neurochirurgica / Ausgabe 11/2020
Print ISSN: 0001-6268
Elektronische ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-020-04508-1

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