The Role Of No Antibiotic Prophylaxis In Clean Neurosurgery

Objective To investigate the efficacy of antibiotic prophylaxis(AP)and the risk factors for postoperative infections in clean neurosurgery.Methods Data were retrospectively collected on all patients who had undergone clean neurosurgical operation at our institution between January 2009 and December 2014.From January 2009 until October 2011,AP was administered to every clean neurosurgical patient.From November 2011 to December 2014,no AP(n-AP)was prescribed for all clean neurosurgical operations.Then we retrospectively collected the shunt surgery cases which were done from 2010.10 to 2015.10 in the 8th Department of neurosurgery in Tian Jin Huan Hu Hospital were chosen.The cases were dived into Antibiotic prophylaxis group and non-Antibiotic prophylaxis group according to the use of antibiotic pre-operation.Analyze the infection rate of the two groups after surgery.Additionally,independent risk factors for infection were investigated using logistic regressions analysis.Results A total of 808 clean neurosurgical cases were included.The AP group comprised 360 surgical cases,including 29 meningitis cases and 2 cases of incision infections,whereas the n-AP group consisted of 448 surgical cases,including 35 meningitis cases and 4 cases of incision infections(P = 0.848).Microorganisms were identified in 7 of 29 cases in the AP group compared with their identification in 22 of 35 cases in the n-AP group(P = 0.002).The percentage of patients with multidrug-resistant bacterial meningitis in the AP group was 57.1% compared with 13.6% in the n-AP group(P = 0.038).The risk factors for postoperative infection were cerebrospinal fluid leakage(odds ratio,27.8;95% confidence interval,9.38–28.55)and surgery time(odds ratio,1.12;95% confidence interval,1.02–1.22).A total of 579 craniotomies were included,The AP group comprised 250 cases with 23 infection cases,and the n-AP group consisted of 329 cases with 30 infection cases.There is no statistical difference between the two groups in infection(P=0.973).The positive rates of bacterial culture were 27.3% in the AP group compared to 59.3% in the n-AP group.The rate did differ significantly between the groups(P=0.025).CSF leakage(odds ratio,38.4;95% confidence interval,10.03-146.58) and surgery time(odds ratio,1.12;95% confidence interval,1.01-1.25)were the independent risk factors for postoperative infection in the logistic regression model.A total of 101 the shunt surgery were chosen,AP group 54 cases with 2 cases infection and n-AP group 47 cases with 3 cases infection,there was no statistical difference between the two groups in infection(P=0.576);Preoperative intracranial infection was closely related to the infection rate(odds ratio,34.50,P=0.000).In the 5 infection cases,3 cases had the positive result of cerebrospinal fluid culture,2 with Epidermis staphylococcus and 1 with enterococcus faecalis.There was no statistical difference between the AP and n-AP group in the days of stay in hospital after surgery,but there was statistically significant difference between the infection group and non-infection group.Conclusions Our results show that in our data set,AP had no preventive effect on postoperative infections in clean neurosurgery.In addition,AP appeared to decrease the positive bacterial culture rate and to promote the emergence of multidrug-resistant bacteria.Cerebrospinal fluid leakage and surgery time were the risk factors for postoperative infection.