Antibiotic prophylaxis for subdural and subgaleal drains

Abstract

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.

Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital.

“…Unfortunately, little research addresses the issue of costs of noncompliance with the PAP in caesarean sections. Instead, studies generally address the average cost of a patient receiving PAP and how costeffective it is compared to a patient who does not receive it [34][35][36]. Jansson et al found 99% savings from compliance with the PAP, [37] which is even higher than what was found in the present research.…”

Prevention of Surgical Site Infections: A Systematic Review of Cost Analyses in the Use of Prophylactic Antibiotics

“…The general characteristics of the included studies are presented in Table 1 . For the further characteristics of the 20 included studies, the most studies came from North-America (Wilson et al, 2008 ; Courville et al, 2012 ; Emohare et al, 2014 ; Matsui et al, 2014 ; Singh et al, 2014 ; Theologis et al, 2014 ; Graves et al, 2016 ; Lewis et al, 2016 ), followed by Asia (Kosus et al, 2010 ; Patil et al, 2011 ; Gulluoglu et al, 2013 ; Ozdemir et al, 2016 ), Europe (Chaudhuri et al, 2006 ; Dhadwal et al, 2007 ; Elliott et al, 2010 ; Joshi et al, 2016 ), Africa (Alekwe et al, 2008 ; El-Mahallawy et al, 2013 ), Australia (Merollini et al, 2013 ), and South America (Ceballos et al, 2017 ). The reviewed articles concerned 14 trial-based studies (Chaudhuri et al, 2006 ; Dhadwal et al, 2007 ; Alekwe et al, 2008 ; Wilson et al, 2008 ; Kosus et al, 2010 ; Patil et al, 2011 ; El-Mahallawy et al, 2013 ; Gulluoglu et al, 2013 ; Emohare et al, 2014 ; Matsui et al, 2014 ; Theologis et al, 2014 ; Joshi et al, 2016 ; Lewis et al, 2016 ; Ozdemir et al, 2016 ) and 6 model-based studies (Elliott et al, 2010 ; Courville et al, 2012 ; Merollini et al, 2013 ; Singh et al, 2014 ; Graves et al, 2016 ; Ceballos et al, 2017 ).…”

“…Two cost-minimization studies on neurosurgery concerned intra-wound vancomycin and Prolonged Prophylactic Systemic Antimicrobials (PPSAs) (Emohare et al, 2014 ; Lewis et al, 2016 ). Firstly, a cohort study, for the purpose of reimbursement to the hospital for SSI costs, evaluated the cost savings achieved by adding intra-wound vancomycin powder as prophylactic therapy to standard intravenous cefazolin in patients who underwent spinal surgery.…”

Prevention of surgical site infections after brain surgery: the prehistoric period to the present

“…5,32,33 Although some authors advocate for the use of prophylactic systemic antibiotics after placement of intracranial drains and devices, others argue this practice does not affect the rate of SSI and is harmful because it increases the risk of growth of resistant gramnegative pathogens and the development of Clostridium difficile. 10,11,16,19,20,22,25 Regarding EVD catheter selection, a survey of members of the Neurocritical Care Society found that many institutions use conventional catheters despite the fact that evidence suggests antibiotic-impregnated EVDs and silver-impregnated EVDs do a better job of preventing SSI. 13,15,19,22,31,35 Lastly, the optimal frequency of CSF sampling to assess for SSI is debated; while some practitioners only sample CSF on an as-needed basis based on the principle that frequent sampling can increase the risk of SSI, others perform routine sampling in an effort to diagnose and subsequently treat SSI quickly.…”