| Background:Surgical site infections (SSIs) after craniotomy may result in disastrous outcomes, even though the incidence is low. The knowledge about risk factors of SSIs can help clinical workers make effective preventive measures. Perioperative antibiotic prophylaxis has been proved as an effective measure to reduce the incidence of SSIs in many studies. However, no study focused on analyzed the influence of different antiobiotic prophylaxis protocols on SSIs. From 2011 to 2012, the antibiotic prophylaxis protocol of patients undergoing craniotomy has been changed significantly because a lot of policies have been carried out to supervise the clinical use of antibiotics by the Ministry of Health of China. Would these changes have influence on the incidence of SSIs?Objective:This study was aimed to compare the antibiotic prophylaxis protocol between 2011 and 2012, calculate the incidence of SSIs of different antibitoc prophylaxis protocol, and analyze the risk factors of SSIs after craniotomy focusing on the influence of antibiotic prophylaxis.Subjects and Methods:This study enrolled all the patients undergoing clean and elective craniotomy from Jan 1st to Jun 30th in 2011 and Jan 1st to Jun 30th in 2012. Medical records of every patient were retrospective reviewed. Information about patient (age, gender, BMI, medical history and length of stay), surgery (date, surgical approach, surgical duration, drainage, blood transfusion, foreign body implantation, and reoperation), antibiotic prophylaxis (drugs, timing, duration) and infection were extracted to establish an Access database. Univariate analysis and multivariate analysis were conducted to identify the risk factors of SSIs and analyze the influence of antibiotic prophylaxis on SSIs by using SPSS 17.0. Results:The overall incidence of SSIs in this study was 9.7% with a total of 1267 cases. In 2011, the most common antibiotic used as prophylaxis was ceftriaxone and the duration of antibiotic prophylaxis for most cases was over 48h. However, in 2012, cefazolin and cefuroxime turned to be the most common antibiotics and most patients had duration of antibiotic prophylaxis within 48h.Previous neurosurgery, duration of surgery, diagnosis of surgery, reoperation, external ventricular drainage, CSF leak, choose of antibiotic used as prophylaxis before surgery and duration of antibiotic prophylaxis were independent risk factors of postcraniotomy SSIs, respectively. In further study, no significant difference was detected about the incidence of SSIs in patients using ceftriaxone, cefazolin or cefuroxime as prophylaxis before surgery. The incidence of SSIs of patients who had duration of prophylaxis within 24h was significantly higher than other patients(p<0.001). However, the incidence of SSIs of patients using antibiotic prophylaxis within 24-48h was not significantly different than those with duration over (p=0.548).Conclusions:After the implementation of regulatory policies on clinical application of antibiotics, the use of antibiotic prophylaxis in patients undergoing craniotomy is more standardizing and rational in 2012 compared to 2011. Our study shows cefazolin and cefuroxime are as good as ceftriaxone in prophylaxis, so we do not recommend ceftriaxone as an option for prophylaxis. Prolonged-use of antibiotic prophylaxis to 48h is better than short-term use within 24h in reducing the incidence of SSIs. However, extended-use over 48h has no more benefit.Thus we suggest the duration of antibiotic prophylaxis of patients undergoing clean and elective craniotomy should be within 24～48h after surgery. |
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