Ultra-short antibiotic prophylaxis guided by preoperative microbiological nasal swabs in endoscopic endonasal skull base surgery

Ceraudo, Marco; Prior, Alessandro; Balestrino, Alberto; Anania, Pasquale; Camera, Marina; Fiaschi, Pietro; Gatto, Federico; Riccardi, Niccolò; Zona, Gianluigi; Rossi, Diego Criminelli

doi:10.1007/s00701-020-04560-x

Cited by 12 publications

(12 citation statements)

References 42 publications

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“…23 Ceraudo et al also reported a promising ultrashort antibiotic regimen of a single dose of antibiotics at anesthesia induction (with a second dose added for surgeries longer than 3 hours) based on nasal swab-related antibiotic protocols in a cohort of 120 patients. 24 However, when comparing the 60 patients undergoing this procedure to the 60 controls, the rates of meningitis and sinusitis during and after hospitalization were not statistically significant. Furthermore, Ceraudo et al described the need for a rectal swab and possible additional antibiotics for patients with risk factors, including previous hospitalizations and comorbidities, such as diabetes and chronic obstructive pulmonary disease, which only made up 7.2% of their experimental cohort.…”

Section: Discussionmentioning

confidence: 90%

Perioperative Antibiotic Use in Endoscopic Endonasal Skull Base Surgery

Nakhla

Villalpando

et al. 2021

J Neurol Surg B Skull Base

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Background Improved evidence-based guidelines on the optimal type and duration of antibiotics for patients undergoing endoscopic endonasal transsphenoidal surgery (EETS) are needed. We analyze the infectious complications among a large cohort of EETS patients undergoing a standardized regimen of cefazolin for 24 hours, followed by cephalexin for 7 days after surgery (clindamycin if penicillin/cephalosporin allergic). Methods A retrospective review of 132 EETS patients from 2018 to 2020 was conducted. Patient, tumor, and surgical characteristics were collected, along with infection rates. Multivariate logistic regression determined the variable(s) independently associated with infectious outcomes. Results Nearly all patients (99%) received postoperative antibiotics with 78% receiving cefazolin, 17% receiving cephalexin, 3% receiving clindamycin, and 2% receiving other antibiotics. Fifty-three patients (40%) had an intraoperative cerebrospinal fluid (CSF) leak, and three patients (2%) developed a postoperative CSF leak requiring surgical repair. Within 30 days, no patients developed meningitis. Five patients (4%) developed sinusitis, two patients (3%) developed pneumonia, and one patient (1%) developed cellulitis at a peripheral intravenous line. Two patients (2%) developed an allergy to cephalexin, requiring conservative management. After adjustment for comorbidities and operative factors, presence of postoperative infectious complications was independently associated with increased LOS (β = 3.7 days; p = 0.001). Conclusion Compared with reported findings in the literature, we report low rates of infectious complications and antibiotic intolerance, despite presence of a heavy burden of comorbidities and high intraoperative CSF leak rates among our cohort. These findings support our standardized 7-day perioperative antibiotic regimen.

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Section: Discussionmentioning

confidence: 90%

Perioperative Antibiotic Use in Endoscopic Endonasal Skull Base Surgery

Nakhla

Villalpando

et al. 2021

J Neurol Surg B Skull Base

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“…From a clinical point of view, of particular importance is that prevention of infection was similarly effective in patients treated with FDC dexamethasone and levofloxacin for only 7 days compared to the control arm of the antibiotic treatment administered for 14 days. Considering that the duration of antibiotic administration is one of the main factors facilitating the appearance of bacterial resistance, the results of this study, which support the efficacy and safety of short antibiotic prophylaxis, can contribute significantly to the policy of containment of the use of antibiotics [ 22 – 24 ]. Indeed, antimicrobial resistance is a global problem, and ocular pathogens are no exception [ 25 ].…”

Section: Discussionmentioning

confidence: 92%

A One-Week Course of Levofloxacin/Dexamethasone Eye Drops: A Review on a New Approach in Managing Patients After Cataract Surgery

et al. 2021

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A new fixed-dose combination of dexamethasone and levofloxacin eye drops has recently been approved for the prevention and treatment of inflammation, and the prevention of infection associated with cataract surgery in adults. This combination has been developed to respond to a series of unmet needs in the practical management of patients undergoing cataract surgery. Namely, despite updated guidelines, many ophthalmologists employ protocols mainly based on their personal experience. As a result, the choice of drugs, treatment duration, and drug association is not

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“…This accounts for the lack of official recommendation by scientific societies. However, while waiting for randomized controlled trials able to solve all the presently unsolved problems, it can be highlighted that recent studies indicate that a short-term antibiotic regimen (cefazolin up to 24 h) or an ultrashort-term antibiotic regimen (ampicillin-sulbactam, a single intraoperative dose) can be effective in reducing the risk of SSIs, mainly meningitis, in patients undergoing endonasal trans-sphenoidal surgery [ 39 , 40 , 41 ]. These regimens could represent a reasonable compromise between the desire to reduce the risk of infectious complications and the need to avoid useless antibiotic prescriptions.…”

Section: Resultsmentioning

confidence: 99%

Surgical Antimicrobial Prophylaxis in Neonates and Children Undergoing Neurosurgery: A RAND/UCLA Appropriateness Method Consensus Study

et al. 2022

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Pediatric neurosurgery is a highly specialized branch of surgery in which surgical site infections (SSIs) are potentially serious complications that can also adversely affect a good surgical outcome, compromising functional recovery and, in some cases, even putting the patient’s life at risk. The main aim of this consensus document is to provide clinicians with a series of recommendations on antimicrobial prophylaxis for neonates and children undergoing neurosurgery. The following scenarios were considered: (1) craniotomy or cranial/cranio-facial approach to craniosynostosis; (2) neurosurgery with a trans-nasal-trans-sphenoidal approach; (3) non-penetrating head injuries; (4) penetrating head fracture; (5) spinal surgery (extradural and intradural); (6) shunt surgery or neuroendoscopy; (7) neuroendovascular procedures. Patients undergoing neurosurgery often undergo peri-operative antibiotic prophylaxis, with different schedules, not always supported by scientific evidence. This consensus provides clear and shared indications, based on the most updated literature. This work has been made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies, and represents, in our opinion, the most complete and up-to-date collection of recommendations on the behavior to be held in the peri-operative setting in this type of intervention, in order to guide physicians in the management of the patient, standardize approaches and avoid abuse and misuse of antibiotics.

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Ultra-short antibiotic prophylaxis guided by preoperative microbiological nasal swabs in endoscopic endonasal skull base surgery

Cited by 12 publications

References 42 publications

Perioperative Antibiotic Use in Endoscopic Endonasal Skull Base Surgery

Perioperative Antibiotic Use in Endoscopic Endonasal Skull Base Surgery

A One-Week Course of Levofloxacin/Dexamethasone Eye Drops: A Review on a New Approach in Managing Patients After Cataract Surgery

Surgical Antimicrobial Prophylaxis in Neonates and Children Undergoing Neurosurgery: A RAND/UCLA Appropriateness Method Consensus Study

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