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Child's Nervous System
Published in: Child's Nervous System 2/2021

01-02-2021 | Ampicillin | Original Article

Reduced rates of infection after myelomeningocele closure associated with standard perioperative antibiotic treatment with ampicillin and gentamicin

Authors: Tobias Finger, Andreas Schaumann, Valentina Pennacchietti, Christoph Bührer, Ulrich-Wilhelm Thomale, Matthias Schulz

Published in: Child's Nervous System | Issue 2/2021

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Abstract

Purpose

Postnatal closure of a myelomeningocele (MMC) is a complex procedure with frequent complications following surgery. Bacterial colonization of the placode may cause infection and subsequent complications. The objectives of this study were to determine the preoperative bacterial colonization rates, to assess the antibiotic regimen, and to evaluate the overall postoperative infection rate.

Methods

All consecutive patients undergoing MMC closure in our hospital from January 2010 to January 2020 were evaluated. Epidemiological data, surgical data, complication characteristics, and microbiological results were documented.

Results

A total of 45 patients were evaluated; in 41 patients, a wound swab of the placode was performed directly before MMC closure (91%). All patients received a prophylactic antibiotic treatment for a mean of 5.6 ± 2.7 days around the performed MMC closure. In three patients with a wound swab (7.3%), a bacterial colonization could be detected—none of the patients developed a subsequent infection. Overall, 7 other patients developed an infection (15.6%), three local surgical site infections, and four shunt-related infections. After applying a standardized perioperative prophylactic antibiotic treatment with ampicillin and gentamicin, the infection rate was observed to be lower compared with that of a non-standardized treatment (6% vs. 45%; p = 0.019).

Conclusions

In neonates who undergo MMC closure in the first 48 h after birth, the colonization rate of the placode was lower than previously reported. While the data presented cannot proof the benefit of a perioperative antibiotic prophylaxis, as compared with no prophylaxis, infection rates are low with a standardized antibiotic regime comprising ampicillin and gentamicin.
Literature
1.
Adzick NS, Thom EA, Spong CY, Brock JW 3rd, Burrows PK, Johnson MP, Howell LJ, Farrell JA, Dabrowiak ME, Sutton LN, Gupta N, Tulipan NB, D’Alton ME, Farmer DL, Investigators M (2011) A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 364:993–1004CrossRef
2.
Kshettry VR, Kelly ML, Rosenbaum BP, Seicean A, Hwang L, Weil RJ (2014) Myelomeningocele: surgical trends and predictors of outcome in the United States, 1988-2010. J Neurosurg Pediatr 13:666–678CrossRef
3.
Boulet SL, Yang Q, Mai C, Kirby RS, Collins JS, Robbins JM, Meyer R, Canfield MA, Mulinare J, National Birth Defects Prevention N (2008) Trends in the postfortification prevalence of spina bifida and anencephaly in the United States. Birth Defects Res A Clin Mol Teratol 82:527–532CrossRef
4.
Wolff T, Witkop CT, Miller T, Syed SB, Force USPST (2009) Folic acid supplementation for the prevention of neural tube defects: an update of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 150:632–639CrossRef
5.
Al-Hakim S, Schaumann A, Schneider J, Schulz M, Thomale UW (2018) Experience in shunt management on revision free survival in infants with myelomeningocele. Childs Nerv Syst 34:1375–1382CrossRef
6.
Schroeder HK, Nunes JC, Madeira L, Moritz JL, Walz R, Linhares MN (2012) Postsurgical infection after myelomeningocele repair: a multivariate analysis of 60 consecutive cases. Clin Neurol Neurosurg 114:981–985CrossRef
7.
Adzick NS, Walsh DS (2003) Myelomeningocele: prenatal diagnosis, pathophysiology and management. Semin Pediatr Surg 12:168–174CrossRef
8.
Cherian J, Staggers KA, Pan IW, Lopresti M, Jea A, Lam S (2016) Thirty-day outcomes after postnatal myelomeningocele repair: a National Surgical Quality Improvement Program Pediatric database analysis. J Neurosurg Pediatr 18:416–422CrossRef
9.
Demir N, Peker E, Gulsen I, Agengin K, Tuncer O (2015) Factors affecting infection development after meningomyelocele repair in newborns and the efficacy of antibiotic prophylaxis. Childs Nerv Syst 31:1355–1359CrossRef
10.
Clemmensen D, Rasmussen MM, Mosdal C (2010) A retrospective study of infections after primary VP shunt placement in the newborn with myelomeningocele without prophylactic antibiotics. Childs Nerv Syst 26:1517–1521CrossRef
11.
National Nosocomial Infections Surveillance S (2004) National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 32:470–485CrossRef
12.
Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36:309–332CrossRef
13.
Prinz V, Bayerl S, Renz N, Trampuz A, Vajkoczy P, Finger T (2019) Sonication improves pathogen detection in ventriculoperitoneal shunt-associated infections. Neurosurgery 85:516–523CrossRef
14.
Anegbe AO, Shokunbi MT, Oyemolade TA, Badejo OA (2019) Intracranial infection in patients with myelomeningocele: profile and risk factors. Childs Nerv Syst 35:2205–2210CrossRef
15.
McDowell MM, Lee PS, Foster KA, Greene S (2018) The use of external ventricular drainage to reduce the frequency of wound complications in myelomeningocele closure. Pediatr Neurosurg 53:100–107CrossRef
16.
Arslan M, Eseoglu M, Gudu BO, Demir I, Kozan A, Gokalp A, Sosuncu E, Kiymaz N (2011) Comparison of simultaneous shunting to delayed shunting in infants with myelomeningocele in terms of shunt infection rate. Turk Neurosurg 21:397–402PubMed
17.
Attenello FJ, Tuchman A, Christian EA, Wen T, Chang KE, Nallapa S, Cen SY, Mack WJ, Krieger MD, McComb JG (2016) Infection rate correlated with time to repair of open neural tube defects (myelomeningoceles): an institutional and national study. Childs Nerv Syst 32:1675–1681CrossRef
18.
Brau RH, Rodriguez R, Ramirez MV, Gonzalez R, Martinez V (1990) Experience in the management of myelomeningocele in Puerto Rico. J Neurosurg 72:726–731CrossRef
19.
Caldarelli M, Di Rocco C, La Marca F (1996) Shunt complications in the first postoperative year in children with meningomyelocele. Childs Nerv Syst 12:748–754CrossRef
20.
Demir N, Peker E, Gulsen I, Kocaman S, Tuncer O, Kirimi E (2016) Powder topical rifampin for reducing infections after neural tube defect surgery in infants. World Neurosurg 95:165–170CrossRef
21.
Gamache FW Jr (1995) Treatment of hydrocephalus in patients with meningomyelocele or encephalocele: a recent series. Childs Nerv Syst 11:487–488CrossRef
22.
Gurbuz MS, Yuksel MO (2020) The association between the timing of shunt placement and shunt infection in hydrocephalus associated with myelomeningocele. Turk Neurosurg 30:94–98PubMed
23.
Kellogg R, Lee P, Deibert CP, Tempel Z, Zwagerman NT, Bonfield CM, Johnson S, Greene S (2018) Twenty years’ experience with myelomeningocele management at a single institution: lessons learned. J Neurosurg Pediatr 22:439–443CrossRef
24.
Lien SC, Maher CO, Garton HJ, Kasten SJ, Muraszko KM, Buchman SR (2010) Local and regional flap closure in myelomeningocele repair: a 15-year review. Childs Nerv Syst 26:1091–1095CrossRef
25.
Rodrigues AB, Krebs VL, Matushita H, de Carvalho WB (2016) Short-term prognostic factors in myelomeningocele patients. Childs Nerv Syst 32:675–680CrossRef
26.
Mazzola CA, Assassi N, Baird LC, Bauer DF, Beier AD, Blount JP, Durham SR, Flannery AM, Klimo P, McClung-Smith C, Nikas DC, Rehring P, Tamber MS, Tyagi R (2019) Congress of neurological surgeons systematic review and evidence-based guidelines for pediatric myelomeningocele: executive summary. Neurosurgery 85:299–301CrossRef
27.
Charney EB, Melchionni JB, Antonucci DL (1991) Ventriculitis in newborns with myelomeningocele. Am J Dis Child 145:287–290PubMed
Metadata
Title
Reduced rates of infection after myelomeningocele closure associated with standard perioperative antibiotic treatment with ampicillin and gentamicin
Authors
Tobias Finger
Andreas Schaumann
Valentina Pennacchietti
Christoph Bührer
Ulrich-Wilhelm Thomale
Matthias Schulz
Publication date
01-02-2021
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 2/2021
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-020-04832-y

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