The Efficacy of Antibacterial Prophylaxis Against the Development of Meningitis After Craniotomy: A Meta-Analysis

Alotaibi, Amal F.; Hulou, M. Maher; Vestal, Matthew; Alkholifi, Faisal K.; Asgarzadeh, Morteza; Coté, David J.; Bi, Wenya Linda; Dunn, Ian F.; Mekary, Rania A.; Smith, Timothy R.

doi:10.1016/j.wneu.2016.02.048

Cited by 30 publications

(26 citation statements)

References 23 publications

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“…Subsequently, some randomized controlled studies were published. Based on these data, some meta-analysis demonstrated that prophylactic antibiotics can significantly reduce the incidence of postoperative ICIs in the brain, 8.80% reduced to 1.90% [ 7 , 23 ]. Therefore, prophylactic antibiotics have become the strategies adopted by most doctors to prevent postoperative infections.…”

Section: Discussionmentioning

confidence: 99%

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Indirect comparison of efficacy between different antibiotic prophylaxis against the intracranial infection after craniotomy

Cao

Wang

Shan

et al. 2020

Antimicrob Resist Infect Control

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Background Many studies had shown that prophylactic use of antibiotics could significantly reduce the intracranial infection (ICI) rate of craniotomy. However, there has been no comparison of these antibiotics. Methods An electronic database search was performed, from inception to June 102,020. Randomized controlled trials (RCT) using different intravenous antibiotics (IVA) against the ICIs after craniotomy were considered. The primary outcome was the incidence rates of ICIs. An indirect treatment comparison (ITC) was conducted to compare the protective effect among the diverse antibiotic prophylaxis to prevent ICIs after craniotomy. Risk of potential bias was assessed. Results A total of 3214 patients after craniotomy in 11 studies were included, 159 patients experienced postoperative ICI, including 33 patients in the antibacterial group and 126 in the control group. The calculate results of meta-analysis showed that except fusidic acid, preoperative intravenous injection of cephalosporin, clindamycin, vancomycin, and penicillin can significantly reduce the incidence of ICI after craniotomy, and ITC showed there was no statistically significance difference in the rates of post craniotomy ICI between the various antibiotics. Conclusion The current evidence shows that low-grade antibacterial drugs can be selected to prevent ICI after craniotomy, but this may be due to the limited number of studies per antibiotic. It still needs more high-quality, large sample RCT to confirm. Systemic review registration PROSPERO CRD42019133369.

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Section: Discussionmentioning

confidence: 99%

“…The extracted data included study characteristics, patient characteristics, interventions, outcomes, and relevant findings. Previous literature shows that few studies have met the criteria [ 7 ]. Therefore, there was no limitation on antibiotic classes, dose, full name, manufacturers and companies in this study.…”

Section: Methodsmentioning

confidence: 99%

Indirect comparison of efficacy between different antibiotic prophylaxis against the intracranial infection after craniotomy

Cao

Wang

Shan

et al. 2020

Antimicrob Resist Infect Control

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“…Limited by the observation in only one subject, our data may indicate that sufficient brain tissue MIC will not be achieved after standard single-dose administration. Since antibiotic prophylaxis significantly reduces postcraniotomy infections and administration of antibiotics is recommended preprocedural to achieve sufficient concentrations prior to dura opening (4,38,39), a loading dose may overcome critical initial underdosing during neurosurgical procedures.…”

Section: Discussionmentioning

confidence: 99%

Concentrations of Cefuroxime in Brain Tissue of Neurointensive Care Patients

Hosmann

Ritscher

Burgmann

et al. 2018

Antimicrob Agents Chemother

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Effective concentrations of antibiotics in brain tissue are essential for antimicrobial therapy of brain infections. However, data concerning cerebral penetration properties of antibiotics for treatment or prophylaxis of central nervous system infections are rare. Six patients suffering subarachnoid hemorrhage and requiring cerebral microdialysis for neurochemical monitoring were included in this study. Free interstitial concentrations of cefuroxime after intravenous application of 1,500 mg were measured by microdialysis in brain tissue, as well as in plasma at steady-state ( = 6) or after single-dose administration ( = 1). At steady state, free area under the concentration-time curve from 0 to 24 h (AUC) values of 389.0 ± 210.3 mg/liter·h and 131.4 ± 72.8 mg/liter·h were achieved for plasma and brain, respectively, resulting in a brain tissue penetration ratio (AUC/AUC) of 0.33 ± 0.1. Plasma and brain tissue concentrations at individual time points correlated well ( = 0.59, = 0.001). At steady-state time over MIC (>MIC) values of >40% of dosing interval were achieved up to an MIC of 16 mg/liter for plasma and 4 mg/liter for brain tissue. Although MIC values could not be achieved in brain tissue for relevant bacteria, current dosing strategies of cefuroxime might be sufficient to treat pathogens with MIC values up to 4 mg/liter. The activity of cefuroxime in brain tissue might be overestimated when relying exclusively on plasma levels. Although currently insufficient data after single dose administration exist, lower brain-plasma ratios observed after the first dose might warrant a loading dose for treatment and perioperative prophylaxis.

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“…El uso de antibiótico profiláctico sistémico es controversial; sin embargo, la evidencia actual halla un efecto benéfico de su administración con la reducción de las tasas de infección postoperatoria, que varía desde un 20 % hasta un 50 % (43) . Igualmente, sugiere la fuga de LCR como el principal factor de riesgo para la infección, por lo que si persiste por más de 7 días debería considerarse el manejo quirúrgico (31,(44)(45)(46)(47)(48)(49)(50)(51) . En intervenciones quirúrgicas como el drenaje ventricular externo se requiere ampliar la evidencia, especialmente en sí es útil la administración continúa hasta el retiro del catéter (31,49) .…”

Section: Antibióticos Sistémicos Profilácticosunclassified

“…Los regímenes de antibióticos usados en los diferentes estudios no son homogéneos. Dentro de estos, se incluyen el uso de vancomicina, oxacilina, clindamicina, cefazolina, trimetoprim sulfametoxazol, ampicilina y cefalosporinas de tercera generación, los cuales cumplen fundamentalmente con el cubrimiento de microorganismos grampositivos, teniendo en cuenta que el principal agente involucrado es el Staphylococcus spp (31,(44)(45)(46)(47)(48)(49)(50)(51)(52)53) . Algunos estudios han favorecido el uso de vancomicina, especialmente en contextos de alta prevalencia de SAMR, pero otros no han encontrado diferencias entre esquemas (53,54,55) .…”

Section: Antibióticos Sistémicos Profilácticosunclassified

Prevención y tratamiento de las infecciones del sitio operatorio en neurocirugía. Estado del arte

García-Casallas

Blanco-Mejía²,

Fuentes

et al. 2019

Iatreia

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El manejo adecuado de las infecciones del sitio operatorio (ISO) en neurocirugía es fundamental para la disminución de la carga de morbilidad y mortalidad en estos pacientes.La sospecha y confirmación diagnóstica asociadas al aislamiento microbiológico son esenciales para asegurar el tratamiento oportuno y el adecuado gerenciamiento de antibióticos. En esta revisión se presenta de forma resumida los puntos fundamentales para la prevención y el tratamiento de infecciones del sitio operatorio en neurocirugía y se incluye un apartado sobre el uso de antibióticos intratecales/intraventriculares.

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The Efficacy of Antibacterial Prophylaxis Against the Development of Meningitis After Craniotomy: A Meta-Analysis

Cited by 30 publications

References 23 publications

Indirect comparison of efficacy between different antibiotic prophylaxis against the intracranial infection after craniotomy

Indirect comparison of efficacy between different antibiotic prophylaxis against the intracranial infection after craniotomy

Concentrations of Cefuroxime in Brain Tissue of Neurointensive Care Patients

Prevención y tratamiento de las infecciones del sitio operatorio en neurocirugía. Estado del arte

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