Risk of Resistant Organisms and Clostridium difficile with Prolonged Systemic Antibiotic Prophylaxis for Central Nervous System Devices

Chauv, Stephanie; Fontaine, G; Hoang, Quang; McKinney, Courtney; Baldwin, Margaret; Buckel, Whitney R.; Collingridge, David; Majercik, Sarah; Wohlt, Paul

doi:10.1007/s12028-016-0254-x

Cited by 16 publications

(9 citation statements)

References 19 publications

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“…The benefit of antibiotic prophylaxis beyond this time frame, however, is not clear and may be associated with increased complications such as infection with resistant organisms or C. diff [29]. In a study of patients with mostly TBI with EVDs or ICP monitors, and prophylactic antibiotic use in 73 % of the cohort, resistant organisms were more frequently found in the study versus control cohort; however, no significant difference was found in frequency of resistant organisms and C. diff rate when adjusting for ICU and hospital LOS and mechanical ventilation [30]. In contrary, limitation of systemic antimicrobial prophylaxis to the first 24 h after EVD placement in a single-center cohort significantly decreased the risk of C. diff infection without adverse effect on the rate of positive CSF cultures [29].…”

Section: Central Nervous System Devicesmentioning

confidence: 99%

Healthcare-Associated Infections in the Neurocritical Care Unit

Busl

2019

Curr Neurol Neurosci Rep

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Purpose of Review This article summarizes updated data and knowledge on healthcare-associated infections in the neurocritical care unit, with a focus on central nervous system infections and systemic infectious complications in patients with acute brain disease. It also reviews the concept of brain injury-induced immune modulation, an underlying mechanism to explain why the neuro-ICU population is particularly susceptible to infections. Recent Findings Healthcare-associated infections in the neuro-ICU are common: up to 40 % of meningitides in the developed world are now healthcare-associated. The number of gram-negative infections is rising. New diagnostic approaches attempt to aid in the diagnosis of healthcare-associated meningitis and ventriculitis. Summary Healthcare-associated infections in the neurocritical care unit remain a challenge for diagnosis, treatment, and prevention. Gaining a better understanding of at-risk patients and development of preventative strategies will be the goal for future investigation.

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Section: Central Nervous System Devicesmentioning

confidence: 99%

Healthcare-Associated Infections in the Neurocritical Care Unit

Busl

2019

Curr Neurol Neurosci Rep

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“…Although antibiotic prophylaxis is currently a cornerstone of SSI prevention, prolonged antibiotic use has been associated with development of resistant organisms and increased SSI risk. In addition, previous antibiotic use is a risk factor for carriage of antibiotic‐resistant organisms, such as extended‐spectrum β‐lactamase‐producing Enterobacteriaceae, in surgical patients.…”

Section: Potential Of Anti‐s Aureus Vaccines To Address Increasing Amentioning

confidence: 99%

Vaccine development to preventStaphylococcus aureussurgical-site infections

Mohamed

Wang

Huec³

et al. 2017

British Journal of Surgery

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Background: Staphylococcus aureus surgical-site infections (SSIs) are a major cause of poor health outcomes, including mortality, across surgical specialties. Despite current advances as a result of preventive interventions, the disease burden of S. aureus SSI remains high, and increasing antibiotic resistance continues to be a concern. Prophylactic S. aureus vaccines may represent an opportunity to prevent SSI.Methods: A review of SSI pathophysiology was undertaken in the context of evaluating new approaches to developing a prophylactic vaccine to prevent S. aureus SSI.Results: A prophylactic vaccine ideally would provide protective immunity at the time of the surgical incision to prevent initiation and progression of infection. Although the pathogenicity of S. aureus is attributed to many virulence factors, previous attempts to develop S. aureus vaccines targeted only a single virulence mechanism. The field has now moved towards multiple-antigen vaccine strategies, and promising results have been observed in early-phase clinical studies that supported the recent initiation of an efficacy trial to prevent SSI. Conclusion:There is an unmet medical need for novel S. aureus SSI prevention measures. Advances in understanding of S. aureus SSI pathophysiology could lead to the development of effective and safe prophylactic multiple-antigen vaccines to prevent S. aureus SSI.

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“…Prolonged systemic antibiotic prophylaxis increases the risk of developing resistant organisms in the central nervous system after implantation of medical devices. 10 Consequently, shorter perioperative courses of antibiotics are recommended. 10 A single topical application of vancomycin is expected to provide needed local prophylaxis for the surgical site while minimizing unnecessary systemic exposure.…”

Section: Discussionmentioning

confidence: 99%

“…10 Consequently, shorter perioperative courses of antibiotics are recommended. 10 A single topical application of vancomycin is expected to provide needed local prophylaxis for the surgical site while minimizing unnecessary systemic exposure. We observed only 2 patients treated with topical vancomycin who exhibited slightly positive vancomycin serum levels (6.3 mg/ml), compared with those who received intravenous vancomycin (10.7 mg/ml).…”

Section: Discussionmentioning

confidence: 99%

Topical vancomycin for neurosurgery wound prophylaxis: an interim report of a randomized clinical trial on drug safety in a diverse neurosurgical population

Radwanski

Christophe

Pucci

et al. 2019

Journal of Neurosurgery

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OBJECTIVEPostoperative surgical site infections (SSIs) in neurosurgical patients carry a significant risk of increased morbidity and mortality. With SSIs accounting for approximately 20% of nosocomial infections and costing approximately $1.6 billion USD annually, there is a need for additional prophylaxis to improve current standards of care. Topical vancomycin is increasingly utilized in instrumented spinal and cardiothoracic procedures, where it has been shown to reduce the risk of SSIs. A randomized controlled trial assessing its efficacy in the general neurosurgical population is currently underway. Here, the authors report their initial impressions of topical vancomycin safety among patients enrolled during the 1st year of the trial.METHODSThis prospective, multicenter, patient-blinded, randomized controlled trial will enroll 2632 patients over 5 years. Here, the authors report the incidence of adverse events, the degree of systemic vancomycin absorption in treated patients, and pattern changes of antibiotic-resistant profiles of Staphylococcus aureus flora among patients enrolled during the 1st year.RESULTSThe topical vancomycin treatment group comprised 257 patients (514 total enrolled patients), of whom 2 exhibited weakly positive serum levels of vancomycin (> 3.0 mg/dl). S. aureus was detected preoperatively in the anterior nares of 35 (18.1%) patients and the skin near the surgical site of 9 (4.7%). Colonization in the nares remained for many patients (71.4%) through postoperative day 30. The authors found a significant association between preoperative S. aureus colonization and postoperative colonization. Seven methicillin-resistant isolates were detected among 6 different patients. Two isolates were detected preoperatively, and 5 were de novo postoperative colonization. No adverse responses to treatment have been reported to date.CONCLUSIONSThe authors’ data indicate that the use of topical vancomycin is safe with no significant adverse effects and minimal systemic absorption, and no development of vancomycin-resistant microorganisms.Clinical trial registration no.: NCT02284126 (clinicaltrials.gov)

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Risk of Resistant Organisms and Clostridium difficile with Prolonged Systemic Antibiotic Prophylaxis for Central Nervous System Devices

Cited by 16 publications

References 19 publications

Healthcare-Associated Infections in the Neurocritical Care Unit

Healthcare-Associated Infections in the Neurocritical Care Unit

Vaccine development to preventStaphylococcus aureussurgical-site infections

Topical vancomycin for neurosurgery wound prophylaxis: an interim report of a randomized clinical trial on drug safety in a diverse neurosurgical population

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