Reduction in <i>Clostridium difficile</i> Infections among Neurosurgical Patients Associated with Discontinuation of Antimicrobial Prophylaxis for the Duration of External Ventricular Drain Placement

Dellit, Timothy H.; Chan, Jeannie D.; Fulton, Charlotte; Pergamit, Ronald; McNamara, Elizabeth; Kim, Louis J.; Ellenbogen, Richard G.; Lynch, John B.

doi:10.1086/675828

Cited by 35 publications

(32 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The Neurocritical Care Society did recommend using antimicrobial-impregnated catheters (moderatequality evidence) and using intraventricular antimicrobials to treat ventriculostomy-related infections when there was a failure to respond to intravenous antibiotics or the organisms involved had very high minimum inhibitory concentrations that would be difficult to achieve in the cerebrospinal fluid (moderate-quality evidence). 115 More recent studies have confirmed that prolonged antibiotics are associated with an increase in nosocomial infections 118 and do not provide more protection. 119 conclusions Significant controversies in antimicrobial prophylaxis remain, and there are numerous opportunities for improving practice through rigorously designed and implemented studies.…”

Section: External Ventricular Drainsmentioning

confidence: 99%

Controversies in Perioperative Antimicrobial Prophylaxis

et al. 2020

View full text Add to dashboard Cite

Although clinical guidelines for antibiotic prophylaxis across a wide array of surgical procedures have been proposed by multidisciplinary groups of physicians and pharmacists, clinicians often deviate from recommendations. This is particularly true when recommendations are based on weak data or expert opinion. The goal of this review is to highlight certain common but controversial topics in perioperative prophylaxis and to focus on the data that does exist for the recommendations being made.

show abstract

Section: External Ventricular Drainsmentioning

confidence: 99%

Controversies in Perioperative Antimicrobial Prophylaxis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…22 Both of these complications impact not just a single patient receiving PPSAs, but also all patients in the hospital because antibiotic use affects the flora to which all patients are exposed. 3,19 Because antibiotic use is associated with the risk of nosocomial infections and growth of resistant bacteria, 5,9,10,19,20 the CDC is exploring approaches to improve monitoring and reporting of inpatient antimicrobial use. 11 The Joint Commission monitors the use of prophylactic antibiotics and rates of discontinuation after 24 hours for a number of surgical procedures, but neurosurgical procedures are not among those tracked at this time.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic prophylaxis for subdural and subgaleal drains

Lewis¹,

Sen

Hill³

et al. 2017

JNS

View full text Add to dashboard Cite

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.

show abstract

“…We acknowledge that there may be variability between physicians as to what clinical circumstances warrant treatment with a full course of antibiotics, as has been noted with respect to discordance in physician preference regarding administration of antimicrobials in patients with pneumonia 27,30 . However, we believe that treatment teams regularly weigh the risks of antibiotics (development of Clostridium difficile 31 , adverse drug reactions including anaphylaxis or systemic toxicity 32,33 , and development of infections due to resistant pathogens 32,34–36 ) against the degree of clinical concern for infection when assessing a positive culture. As such, if a treatment team feels a patient warrants administration of at least seven days of antibiotics, provided that there is robust clinical data to support this, the patient should be categorized as having a VRI, and if a treatment team feels a positive culture should be treated as a contaminant, the patient should not be classified as having a VRI.…”

Section: Limitationsmentioning

confidence: 99%

Ventriculostomy-related infections: The performance of different definitions for diagnosing infection

Lewis

Wahlster

Karinja

et al. 2015

British Journal of Neurosurgery

View full text Add to dashboard Cite

Introduction Comparison of rates of ventriculostomy-related infections (VRI) across institutions is difficult due to the lack of a standard definition. We sought to review published definitions of VRI and apply them to a test cohort to determine the degree of variability in VRI diagnosis. Materials and Methods We conducted a PubMed search for definitions of VRI using the search strings “ventriculostomy-related infection” and “ventriculostomy-associated infection.” We applied these definitions to a test cohort of 18 positive cerebrospinal fluid (CSF) cultures taken from ventriculostomies at two institutions to compare the frequency of infection using each definition. Results We found 16 unique definitions of VRI. When the definitions were applied to the test cohort, the frequency of infection ranged from 22–94% (median 61% with interquartile range (IQR) 56–74%). The concordance between VRI diagnosis and treatment with VRI-directed antibiotics for at least seven days ranged from 56–89% (median 72%, IQR 71–78%). Conclusions The myriad of definitions in the literature produce widely different frequencies of infection. In order to compare rates of VRI between institutions for the purposes of qualitative metrics and research, a consistent definition of VRI is needed.

show abstract

Reduction in Clostridium difficile Infections among Neurosurgical Patients Associated with Discontinuation of Antimicrobial Prophylaxis for the Duration of External Ventricular Drain Placement

Cited by 35 publications

References 8 publications

Controversies in Perioperative Antimicrobial Prophylaxis

Controversies in Perioperative Antimicrobial Prophylaxis

Antibiotic prophylaxis for subdural and subgaleal drains

Ventriculostomy-related infections: The performance of different definitions for diagnosing infection

Contact Info

Product

Resources

About