Top

Published in:

01-11-2020 | Antibiotic | Original Article - Infection

Reduction in the infection rate of cranioplasty with a tailored antibiotic prophylaxis: a nonrandomized study

Authors: Igor Paredes, Alfonso Lagares, Rafael San-Juan, Ana María Castaño-León, Pedro-Antonio Gómez, Luis Jimenez-Roldán, Irene Panero, Carla Eiriz, Daniel García-Perez, Luis Miguel Moreno, Angel Perez-Nuñez, Pedro Gonzalez-León, José Antonio F. Alén

Published in: Acta Neurochirurgica | Issue 11/2020

Abstract

Background

Cranioplasty carries a high risk of surgical site infections (SSIs) for a scheduled procedure, particularly with antibiotic-resistant bacteria.

Methods

The goal of this retrospective study was to measure the effect of tailored antibiotic prophylaxis on SSIs resulting from cranioplasties. The authors collected a prospective database of cranioplasties from 2009 to 2018. Risk factors for SSI were registered, as well as infection occurring during the first year postoperatively. A new protocol was initiated in 2016 consisting of antibiotic prophylaxis tailored to the colonizing flora of the skin of the scalp and decolonization of patients who were nasal carriers of methicillin-resistant S. aureus (MRSA); infection rates were compared.

Results

One hundred nine cranioplasties were identified, 64 in the old protocol and 45 in the new protocol. Of the 109 cranioplasties, 16 (14.7%) suffered an infection, 14 (21.9%) in the old protocol group and 2 (4.4%) in the new protocol group (OR for the new protocol 0.166, 95% CI 0.036–0.772). Multiple surgeries (OR 3.44), Barthel ≤ 70 (OR 3.53), and previous infection (OR 3.9) were risk factors for SSI. Of the bacteria identified in the skin of the scalp, 22.2% were resistant to routine prophylaxis (cefazoline). Only one patient was identified as a nasal carrier of MRSA and was decolonized.

Conclusions

A high percentage of bacteria resistant to routine prophylaxis (cefazoline) was identified in the skin of these patients’ scalps. The use of tailored antibiotic prophylaxis reduced significantly the infection rate in this particular set of patients.

Abode-Iyamah KO, Chiang HY, Winslow N, Park B, Zanaty M, Dlouhy BJ, Flouty OE, Rasmussen ZD, Herwaldt LA, Greenlee JD (2018) Risk factors for surgical site infections and assessment of vancomycin powder as a preventive measure in patients undergoing first-time cranioplasty. J Neurosurg 128:1241–1249. https://doi.org/10.3171/2016.12.jns161967CrossRefPubMed

Acciarri N, Palandri G, Cuoci A, Valluzzi A, Lanzino G (2016) Cranioplasty in neurosurgery: is there a way to reduce complications? J Neurosurg Sci

Agarwal N, Agarwal P, Querry A, Mazurkiewicz A, Tempel ZJ, Friedlander RM, Gerszten PC, Hamilton DK, Okonkwo DO, Kanter AS (2018) Implementation of an infection prevention bundle and increased physician awareness improves surgical outcomes and reduces costs associated with spine surgery. J Neurosurg Spine 29:108–114. https://doi.org/10.3171/2017.11.SPINE17436CrossRefPubMed

Albert H, Bataller W, Masroor N, Doll M, Cooper K, Spencer P, Winborne D, Zierden EM, Stevens MP, Scott M, Bearman G (2019) Infection prevention and enhanced recovery after surgery: a partnership for implementation of an evidence-based bundle to reduce colorectal surgical site infections. Am J Infect Control 47:718–719. https://doi.org/10.1016/j.ajic.2018.11.004CrossRefPubMed

Arocho-Quinones EV, Huang CC, Ward BD, Pahapill PA (2019) Care bundle approach to minimizing infection rates after neurosurgical implants for neuromodulation: a single-surgeon experience. World Neurosurgery 128:e87–e97. https://doi.org/10.1016/j.wneu.2019.04.003CrossRefPubMedPubMedCentral

Bang JH, Cho KT, Park SY (2015) Prophylactic effect of Vancomycin on infection after cranioplasty in methicillin-resistant Staphylococcus aureus carriers with traumatic brain injury. Korean J Neurotrauma 11:81–86. https://doi.org/10.13004/kjnt.2015.11.2.81CrossRefPubMedPubMedCentral

Baumeister S, Peek A, Friedman A, Levin LS, Marcus JR (2008) Management of postneurosurgical bone flap loss caused by infection. Plastic and Reconstructive Surgery 122:195e–208e. https://doi.org/10.1097/PRS.0b013e3181858eeeCrossRefPubMed

Bibbo C, Patel DV, Gehrmann RM, Lin SS (2005) Chlorhexidine provides superior skin decontamination in foot and ankle surgery: a prospective randomized study. Clin Orthop Relat Res 438:204–208CrossRef

Bobinski L, Koskinen LO, Lindvall P (2013) Complications following cranioplasty using autologous bone or polymethylmethacrylate—retrospective experience from a single center. Clin Neurol Neurosurg 115:1788–1791. https://doi.org/10.1016/j.clineuro.2013.04.013CrossRefPubMed

10.

Chaturvedi J, Botta R, Prabhuraj AR, Shukla D, Bhat DI, Devi BI (2016) Complications of cranioplasty after decompressive craniectomy for traumatic brain injury. British Journal of Neurosurgery 30:264–268CrossRef

11.

Chidester JR, Danci I, Lewis P, Biskup N, Kim H, Gupta S (2016) Antibiogram for periprosthetic infections: a tool for better informed selection of empiric antibiotics for surgical site infections. Ann Plast Surg 76(Suppl 3):S158–S161. https://doi.org/10.1097/sap.0000000000000803CrossRefPubMed

12.

Des Jarlais DC, Lyles C, Crepaz N, Group T (2004) Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Am J Public Health 94:361–366. https://doi.org/10.2105/ajph.94.3.361CrossRefPubMedPubMedCentral

13.

Dumville JC, Gray TA, Walter CJ, Sharp CA, Page T, Macefield R, Blencowe N, Milne TK, Reeves BC, Blazeby J (2016) Dressings for the prevention of surgical site infection. Cochrane Database Syst Rev 12:CD003091. https://doi.org/10.1002/14651858.CD003091.pub4CrossRefPubMed

14.

Elbur AI, Yousif MA, El-Sayed AS, Abdel-Rahman ME (2013) Prophylactic antibiotics and wound infection. Journal of Clinical and Diagnostic Research 7:2747–2751. https://doi.org/10.7860/jcdr/2013/6409.3751CrossRefPubMed

15.

Featherall J, Miller JA, Bennett EE, Lubelski D, Wang H, Khalaf T, Krishnaney AA (2016) Implementation of an infection prevention bundle to reduce surgical site infections and cost following spine surgery. JAMA Surg 151:988–990. https://doi.org/10.1001/jamasurg.2016.1794CrossRefPubMed

16.

Glotzbecker MP, Riedel MD, Vitale MG, Matsumoto H, Roye DP, Erickson M, Flynn JM, Saiman L (2013) What’s the evidence? Systematic literature review of risk factors and preventive strategies for surgical site infection following pediatric spine surgery. J Pediatr Orthop 33:479–487. https://doi.org/10.1097/BPO.0b013e318285c507CrossRefPubMed

17.

Goh SSC (2017) Post-sternotomy mediastinitis in the modern era. J Card Surg 32:556–566. https://doi.org/10.1111/jocs.13189CrossRefPubMed

18.

Gomez PA, Castano Leon AM, Lora D, Cepeda S, Lagares A (2018) Final outcome trends in severe traumatic brain injury: a 25-year analysis of single center data. Acta Neurochir 160:2291–2302. https://doi.org/10.1007/s00701-018-3705-7CrossRefPubMed

19.

Herteleer M, Ectors N, Duflou J, Van Calenbergh F (2017) Complications of skull reconstruction after decompressive craniectomy. Acta Chir Belg 117:149–156. https://doi.org/10.1080/00015458.2016.1264730CrossRefPubMed

20.

Hill CS, Luoma AM, Wilson SR, Kitchen N (2012) Titanium cranioplasty and the prediction of complications. Br J Neurosurg 26:832–837. https://doi.org/10.3109/02688697.2012.692839CrossRefPubMed

21.

Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 13:606–608CrossRef

22.

Ikeda H, Kurisu K, Kihira K (2004) Vancomycin ointment for MRSA infection at a cranioplasty site. Ann Pharmacother 38:70–72. https://doi.org/10.1345/aph.1D178CrossRefPubMed

23.

Jorger AK, Wimmer N, Lange N, Wagner A, Janssen I, Krieg S, Meyer B, Shiban E (2018) The implementation of an infection prevention bundle reduces surgical site infections following cranial surgery. Acta Neurochir 160:2307–2312. https://doi.org/10.1007/s00701-018-3704-8CrossRefPubMed

24.

Le C, Guppy KH, Axelrod YV, Hawk MW, Silverthorn J, Inacio MC, Akins PT (2014) Lower complication rates for cranioplasty with peri-operative bundle. Clin Neurol Neurosurg 120:41–44. https://doi.org/10.1016/j.clineuro.2014.02.009CrossRefPubMed

25.

Li S, Rong H, Zhang X, Zhang Z, Wang C, Tan R, Wang Y, Zheng T, Zhu T (2019) Meta-analysis of topical vancomycin powder for microbial profile in spinal surgical site infections. Eur Spine J 28:2972–2980. https://doi.org/10.1007/s00586-019-06143-6CrossRefPubMed

26.

Liu H, Dong X, Yin Y, Chen Z, Zhang J (2017) Reduction of surgical site infections after cranioplasty with perioperative bundle. The Journal of Craniofacial Surgery 28:1408–1412. https://doi.org/10.1097/scs.0000000000003650CrossRefPubMed

27.

Liu Z, Norman G, Iheozor-Ejiofor Z, Wong JK, Crosbie EJ, Wilson P (2017) Nasal decontamination for the prevention of surgical site infection in Staphylococcus aureus carriers. Cochrane Database Syst Rev 5:CD012462. https://doi.org/10.1002/14651858.CD012462.pub2CrossRefPubMed

28.

Liu Z, Dumville JC, Norman G, Westby MJ, Blazeby J, McFarlane E, Welton NJ, O'Connor L, Cawthorne J, George RP, Crosbie EJ, Rithalia AD, Cheng HY (2018) Intraoperative interventions for preventing surgical site infection: an overview of Cochrane reviews. Cochrane Database Syst Rev 2:CD012653. https://doi.org/10.1002/14651858.CD012653.pub2CrossRefPubMed

29.

Loke HY, Kyaw WM, Chen MIC, Lim JW, Ang B, Chow A (2019) Length of stay and odds of MRSA acquisition: a dose-response relationship? Epidemiol Infect 147:e223. https://doi.org/10.1017/S0950268819001110CrossRefPubMedPubMedCentral

30.

Maciejczak A, Wolan-Nieroda A, Walaszek M, Kolpa M, Wolak Z (2019) Antibiotic prophylaxis in spine surgery: a comparison of single-dose and 72-hour protocols. J Hosp Infect 103:303–310. https://doi.org/10.1016/j.jhin.2019.04.017CrossRefPubMed

31.

Mahadeva S, Sam IC, Khoo BL, Khoo PS, Goh KL (2009) Antibiotic prophylaxis tailored to local organisms reduces percutaneous gastrostomy site infection. Int J Clin Pract 63:760–765. https://doi.org/10.1111/j.1742-1241.2008.01881.xCrossRefPubMed

32.

Malcolm JG, Rindler RS, Chu JK, Grossberg JA, Pradilla G, Ahmad FU (2016) Complications following cranioplasty and relationship to timing: a systematic review and meta-analysis. Journal of Clinical Neuroscience 33:39–51. https://doi.org/10.1016/j.jocn.2016.04.017CrossRefPubMed

33.

Malcolm JG, Mahmooth Z, Rindler RS, Allen JW, Grossberg JA, Pradilla G, Ahmad FU (2018) Autologous cranioplasty is associated with increased reoperation rate: a systematic review and meta-analysis. World Neurosurgery 116:60–68. https://doi.org/10.1016/j.wneu.2018.05.009CrossRefPubMed

34.

Matsen FA 3rd, Russ SM, Bertelsen A, Butler-Wu S, Pottinger PS (2015) Propionibacterium can be isolated from deep cultures obtained at primary arthroplasty despite intravenous antimicrobial prophylaxis. J Shoulder Elb Surg 24:844–847. https://doi.org/10.1016/j.jse.2014.10.016CrossRef

35.

Mendes D, Alves C, Batel-Marques F (2017) Number needed to treat (NNT) in clinical literature: an appraisal. BMC Med 15:112. https://doi.org/10.1186/s12916-017-0875-8CrossRefPubMedPubMedCentral

36.

Moles A, Heudes PM, Amelot A, Cristini J, Salaud C, Roualdes V, Riem T, Martin SA, Raoul S, Terreaux L, Bord E, Buffenoir K (2018) Long-term follow-up comparative study of hydroxyapatite and autologous cranioplasties: complications, cosmetic results, osseointegration. World Neurosurgery 111:e395–e402. https://doi.org/10.1016/j.wneu.2017.12.082CrossRefPubMed

37.

Mukherjee S, Thakur B, Haq I, Hettige S, Martin AJ (2014) Complications of titanium cranioplasty—a retrospective analysis of 174 patients. Acta Neurochir 156:989–998; discussion 998. https://doi.org/10.1007/s00701-014-2024-xCrossRefPubMed

38.

Paredes I, Castano-Leon AM, Munarriz PM, Martinez-Perez R, Cepeda S, Sanz R, Alen JF, Lagares A (2015) Cranioplasty after decompressive craniectomy. A prospective series analyzing complications and clinical improvement. Neurocirugia (Asturias, Spain) 26:115–125. https://doi.org/10.1016/j.neucir.2014.10.001CrossRef

39.

Rosseto RS, Giannetti AV, de Souza Filho LD, Faleiro RM (2015) Risk factors for graft infection after cranioplasty in patients with large hemicranial bony defects. World Neurosurgery 84:431–437. https://doi.org/10.1016/j.wneu.2015.03.045CrossRefPubMed

40.

Rubeli SL, D'Alonzo D, Mueller B, Bartlome N, Fankhauser H, Bucheli E, Conen A, Fandino J, Fux CA (2019) Implementation of an infection prevention bundle is associated with reduced surgical site infections in cranial neurosurgery. Neurosurg Focus 47:E3. https://doi.org/10.3171/2019.5.FOCUS19272CrossRefPubMed

41.

Sadigursky D, Sousa MD, Cajaiba YGL, Martins RR, Lobao DMV (2019) Infectious prophylaxis with intrawound Vancomycin powder in orthopedic surgeries: systematic review with meta-analysis. Rev Bras Ortop (Sao Paulo) 54:617–626. https://doi.org/10.1016/j.rbo.2017.12.003CrossRef

42.

Schuss P, Vatter H, Marquardt G, Imohl L, Ulrich CT, Seifert V, Guresir E (2012) Cranioplasty after decompressive craniectomy: the effect of timing on postoperative complications. J Neurotrauma 29:1090–1095. https://doi.org/10.1089/neu.2011.2176CrossRefPubMed

43.

Schweizer ML, Herwaldt LA (2012) Surgical site infections and their prevention. Curr Opin Infect Dis 25:378–384. https://doi.org/10.1097/QCO.0b013e32835532f7CrossRefPubMed

44.

Sundseth J, Sundseth A, Berg-Johnsen J, Sorteberg W, Lindegaard KF (2014) Cranioplasty with autologous cryopreserved bone after decompressive craniectomy: complications and risk factors for developing surgical site infection. Acta Neurochir 156:805–811; discussion 811. https://doi.org/10.1007/s00701-013-1992-6CrossRefPubMed

45.

Tfifha M, Ferjani A, Mallouli M, Mlika N, Abroug S, Boukadida J (2018) Carriage of multidrug-resistant bacteria among pediatric patients before and during their hospitalization in a tertiary pediatric unit in Tunisia. Libyan J Med 13:1419047. https://doi.org/10.1080/19932820.2017.1419047CrossRefPubMed

46.

Webster J, Alghamdi A (2015) Use of plastic adhesive drapes during surgery for preventing surgical site infection. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD006353.pub4

47.

Wui SH, Kim KM, Ryu YJ, Kim I, Lee SJ, Kim J, Kim C, Park S (2016) The autoclaving of autologous bone is a risk factor for surgical site infection after cranioplasty. World Neurosurgery 91:43–49. https://doi.org/10.1016/j.wneu.2016.03.066CrossRefPubMed

Title: Reduction in the infection rate of cranioplasty with a tailored antibiotic prophylaxis: a nonrandomized study
Authors: Igor Paredes
Alfonso Lagares
Rafael San-Juan
Ana María Castaño-León
Pedro-Antonio Gómez
Luis Jimenez-Roldán
Irene Panero
Carla Eiriz
Daniel García-Perez
Luis Miguel Moreno
Angel Perez-Nuñez
Pedro Gonzalez-León
José Antonio F. Alén
Publication date: 01-11-2020
Publisher: Springer Vienna
Keywords: Antibiotic
Cefazolin
Published in: Acta Neurochirurgica / Issue 11/2020
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-020-04508-1

At a glance: The STEP trials

Springer Medicine

Reduction in the infection rate of cranioplasty with a tailored antibiotic prophylaxis: a nonrandomized study

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2020

Early unplanned readmission of neurosurgical patients after treatment of intracranial lesions: a comparison between surgical and non-surgical intervention group

Occurrence and management of postoperative pneumocephalus using the semi-sitting position in vestibular schwannoma surgery

The impact of hypertonic saline on cerebrovascular reactivity and compensatory reserve in traumatic brain injury: an exploratory analysis

Flat-shaped posterior cranial fossa was associated with poor outcomes of microvascular decompression for primary hemifacial spasm

Management of CVJ tuberculosis: the changing paradigm

Development of machine learning-based preoperative predictive analytics for unruptured intracranial aneurysm surgery: a pilot study