Prophylactic antibiotic trends in transsphenoidal surgery for pituitary lesions

Abstract

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.

Antibiotic prophylaxis for subdural and subgaleal drains

“…Our rates of SSI and CDI are similar to those reported in prior studies on postoperative infection. 1,2 Although it can be tempting to administer antibiotics to patients "to be safe" 17 or "just in case," 13 our results show that PPSAs use is not associated with a protective benefit, but instead is associated with a risk of harm. Our findings are consistent with the observations of Abu Hamdeh et al, who reported no significant relationship between the presence of a drain and the development of an SSI in their prospective study of 448 patients undergoing intracranial tumor resections, bur hole biopsies, or bur hole placement for subdural hematoma drainage.…”

Analysis of the Bacterial Flora in the Nasal Cavity and the Sphenoid Sinus Mucosa in Patients Operated on with an Endoscopic Endonasal Transsphenoidal Approach

“… 8) Cephalosporins tend to be administered to prevent postoperative meningitis. 15) Orland et al described the usefulness of a third-generation cephalosporin as a prophylactic antibiotic. 8) Third-generation cephalosporins reach the levels in the CSF that are sufficient to inhibit Staphylococcus species and gram-negative bacilli, 16) and they are useful for reducing the risk of meningitis.…”

Current perioperative practice patterns for minimizing surgical site infection during rhinologic procedures

“…Brown et al prospectively investigated the use of antibiotics in endoscopic skull‐base procedures and found that the risk of central nervous system infections is low, in cases with and without compromise of the dura. Another study surveyed physicians performing transsphenoidal surgery for pituitary lesions and found that 91% of responders indicated that there was no strong evidence supporting antibiotic use, but 81% used them just to be safe . Therefore, there appears to be inadequate evidence to reach a definitive conclusion regarding the benefit of perioperative antibiotics in these procedures.…”