Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures

Ratilal, Bernardo O; Costa, João; Sampaio, Cristina

doi:10.1002/14651858.cd004884.pub2

Cited by 70 publications

(54 citation statements)

References 22 publications

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“…On the one hand, the results of randomized controlled studies from obstetrics and colorectal surgery strongly favor chemoprophylaxis [7,10]. However, data from elective ear surgery and basilar skull fractures do not demonstrate a convincing role for chemoprophylaxis [9,11]. Data obtained from clean neurosurgical procedures may not be applicable to pituitary surgery [4,5].…”

Section: Discussionmentioning

confidence: 99%

Prophylactic antibiotic trends in transsphenoidal surgery for pituitary lesions

Little

White

2010

Pituitary

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Pituitary surgery involves operating in the nasal cavity, which is considered a clean-contaminated wound. In the absence of evidence-based guidelines for preventing surgical site infections in trans-sphenoidal surgery, a survey of current opinion on prophylactic antibiotics might help elucidate the current acceptable practices and identify opportunities for prospective clinical trials that could lead to the development of practice guidelines. An on-line, 10-question, multiple-choice survey was distributed by e-mail link to the membership of the International Society of Pituitary Surgeons. Sixty-nine members responded to the survey. Ninety-one percent indicated that there was no strong evidence supporting antibiotic use, but 81% used them to be safe. Ninety percent of respondents used intravenous prophylactic antibiotics, while only 16% used intranasal antibiotics. The most commonly used antibiotics were cephalosporins (72%) and penicillins (21%). Seventy-six percent used antibiotics for 24 h or less after surgery. The most commonly reported indications for prophylactic antibiotics were prevention of meningitis and sinusitis. The results of the survey describe current acceptable practices for chemoprophylaxis in patients undergoing transsphenoidal pituitary surgery.

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Section: Discussionmentioning

confidence: 99%

Prophylactic antibiotic trends in transsphenoidal surgery for pituitary lesions

Little

White

2010

Pituitary

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“…Although no prospective controlled trials have examined this question, a metaanalysis that included 1241 patients with basilar skull fracture, in which 719 patients received prophylactic antibiotics and 522 did not, use of prophylactic antibiotics was not found to prevent meningitis in patients with basilar skull fracture, even in those with CSF leak [40]. Similar results were also found in a Cochrane review, which included 208 participants in four randomized controlled trials and 2168 patients enrolled into nonrandomized controlled trials [41]. These data do not support the use of prophylactic antimicrobial therapy in patients with basilar skull fracture, with or without CSF leak, because their use does not change the incidence of post-traumatic bacterial meningitis and may result in the selection and growth or resistant microorganisms.…”

Section: Preventionmentioning

confidence: 65%

Healthcare-Associated Bacterial Meningitis

Laxmi

Tunkel

2011

Curr Infect Dis Rep

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Healthcare-associated bacterial meningitis may occur after neurosurgical procedures, head trauma, and following placement of external or internal ventricular catheters. The likely microorganisms that cause meningitis in this setting (ie, staphylococci and gram-negative bacilli) are different from those that cause meningitis in the community setting. Any clinical suspicion of healthcare-associated bacterial meningitis should prompt a diagnostic evaluation (neuroimaging and cerebrospinal fluid analysis) and appropriate management. Empiric antimicrobial therapy should be directed toward the likely infecting pathogen; based upon clinical response, intraventricular administration of specific agents may be required. With the emergence of resistant gram-negative bacilli (especially Acinetobacter baumannii) that may cause healthcare-associated meningitis, empiric therapy with a carbapenem, with or without an aminoglycoside administered by the intraventricular or intrathecal route, is recommended; colistin (given intravenously and/or intraventricularly) can be used if the organism is subsequently found to be resistant to carbapenems.

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“…A Cochrane review of the evidence for antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures was published in 2011. 7 The review comprises a meta-analysis of 5 randomised, controlled trials (RCTs) and 17 non-RCTs comparing different types of antibiotic prophylaxis with placebo or no intervention in patients with a skull base fracture (although not necessarily an active CSF leak). The results do not support the use of prophylactic antibiotics in patients with a skull base fracture, with or without a CSF leak.…”

Section: Discussionmentioning

confidence: 99%