World neurosurgery · 2018
Effect of Staphylococcal Decolonization Regimen and Change in Antibiotic Prophylaxis Regimen on Incidence of Postcraniotomy Aseptic Meningitis.
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Gupta Ankush, Nair Reman Ramesh, Moorthy Ranjith K, Rajshekhar Vedantam
Аннотация
OBJECTIVE: To study the effect of a staphylococcal decolonization regimen (SDR) and change in antibiotic prophylaxis regimen on postoperative meningitis (bacterial and aseptic) rates in patients undergoing elective cranial surgery.
METHODS: Data on elective craniotomy (supratentorial and infratentorial) were collected retrospectively for a total of 4 years-2 years before (2011-2012; group A) and 2 years after (2014-2015; group B) initiation of a SDR and a change in the antibiotic prophylaxis regimen (from chloramphenicol to ceftriaxone) in a neurosurgical unit of a tertiary care hospital. The SDR consisted of a 4% chlorhexidine scrub bath once a day and 10% betadine ointment application intranasally twice daily for ≥2 days before surgery.
RESULTS: A total of 1349 patients (GROUP A, n = 622; group B, n = 727) were included in the present study, of whom 806 (59.7%) were males. Of the 1349 patients, 43 (3.2%) developed postoperative meningitis. Of these 43 patients, 8 (0.6%) had bacterial meningitis (BM) and 35 (2.6%) had aseptic meningitis (AM). A reduction occurred in the incidence of both BM and AM in group B; however, the reduction was statistically significant only for AM (P = 0.48 for BM; P = 0.019 for AM). Multivariate analysis showed that the initiation of an SDR conferred a significant protective effect against developing postoperative AM (relative risk, 0.31; 95% confidence interval, 0.14-0.70; P = 0.005).
CONCLUSIONS: Our data showed that the incidence of AM can be reduced with an SDR and appropriate antibiotic prophylaxis. These findings lend support to the suspicion that AM might be a form of low-grade BM possibly due to a staphylococcal infection.
METHODS: Data on elective craniotomy (supratentorial and infratentorial) were collected retrospectively for a total of 4 years-2 years before (2011-2012; group A) and 2 years after (2014-2015; group B) initiation of a SDR and a change in the antibiotic prophylaxis regimen (from chloramphenicol to ceftriaxone) in a neurosurgical unit of a tertiary care hospital. The SDR consisted of a 4% chlorhexidine scrub bath once a day and 10% betadine ointment application intranasally twice daily for ≥2 days before surgery.
RESULTS: A total of 1349 patients (GROUP A, n = 622; group B, n = 727) were included in the present study, of whom 806 (59.7%) were males. Of the 1349 patients, 43 (3.2%) developed postoperative meningitis. Of these 43 patients, 8 (0.6%) had bacterial meningitis (BM) and 35 (2.6%) had aseptic meningitis (AM). A reduction occurred in the incidence of both BM and AM in group B; however, the reduction was statistically significant only for AM (P = 0.48 for BM; P = 0.019 for AM). Multivariate analysis showed that the initiation of an SDR conferred a significant protective effect against developing postoperative AM (relative risk, 0.31; 95% confidence interval, 0.14-0.70; P = 0.005).
CONCLUSIONS: Our data showed that the incidence of AM can be reduced with an SDR and appropriate antibiotic prophylaxis. These findings lend support to the suspicion that AM might be a form of low-grade BM possibly due to a staphylococcal infection.