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OBJECTIVE The authors sought to determine the effects of eliminating the use of prolonged prophylactic systemic antibiotics (PPSAs) in patients with subdural and subgaleal drains. METHODS Using a retrospective database, the authors collected data for patients over the age of 17 years who had undergone cranial surgery at their institution between December 2013 and July 2014 (PPSAs period) or between December 2014 and July 2015 (non-PPSAs period) and had subdural or subgaleal drains left in place postoperatively. RESULTS One hundred five patients in the PPSAs period and 80 in the non-PPSAs period were identified. The discontinuation of PPSAs did not result in an increase in the frequency of surgical site infection (SSI). The frequency of Clostridium difficile (CDI) and the growth of resistant bacteria were reduced in the non-PPSAs period in comparison with the PPSAs period. In the 8 months after the drain prophylaxis protocol was changed, $93,194.63 were saved in the costs of antibiotics and complications related to antibiotics. CONCLUSIONS After discontinuing PPSAs for patients with subdural or subgaleal drains at their institution, the authors did not observe an increase in the frequency of SSI. They did, however, note a decrease in the frequency of CDI and the growth of resistant organisms. It appears that not only can patients in this population do without PPSAs, but also that complications are avoided when antibiotic use is limited to 24 hours after surgery.

After discontinuing PA for patients who had instrumented spinal procedures, we did not observe an increase in the frequency of SSI. We did, however, note that there was a non-significant decrease in the frequency of growth of resistant organisms. These findings suggest that patients in this population do not need PA, and complications can be reduced if PA are withheld.

After discontinuing PPSAs for patients with noninstrumented spinal procedures, as is recommended for quality improvement, we saw a nonsignificant increase in our rate of SSIs. Further monitoring of this population is warranted.

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Summary Comparison of the action of toxic viable Rickettsia mooseri with that of a Boivin type endotoxin from Escherichia coli in mice revealed striking differences. One LD50 of the endotoxin caused a prompt depression in total leukocyte count followed by leukocytosis, whereas 1 LD50 of the toxic rickettsial suspension failed to cause a significant shift in total leukocyte count toward a comparable response pattern. Reticuloendothelial blockade with colloidal iron saccharate markedly increased the susceptibility of mice to the lethal action of the endotoxin, but failed to alter their susceptibility to the toxic action of the rickettsiae. Moreover, mice rendered tolerant to endotoxin remained as susceptible to the rickettsial toxin as normal control mice. It is concluded that the mouse lethal toxin of R. mooseri and classic bacterial endotoxin differ significantly in several important properties.

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