Preoperative antibiotic prophylaxis regimen in brain tumour surgery in Sweden: a quasi-experimental study
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ORIGINAL ARTICLE - INFECTION
Preoperative antibiotic prophylaxis regimen in brain tumour surgery in Sweden: a quasi-experimental study Simon Skyrman 1,2 & Jiri Bartek Jr 1,3,4 & Maryam Haghighi 1 & Ida Fornebo 1 & Tomas Skoglund 5,6 & Asgeir Store Jakola 5,6 & Ann-Christin von Vogelsang 1 & Petter Förander 1 Received: 15 January 2020 / Accepted: 23 March 2020 # The Author(s) 2020
Abstract Background There has been varied clinical practice concerning antibiotic prophylaxis in patients undergoing craniotomy. In Sweden, both Cloxacillin and Cefuroxime have frequently been used. We aimed to study the clinical effectiveness of these two regimens. Methods A quasi-experimental design was used. The sample consisted of 580 adult (> 18 years) patients operated 2012–2015, of which 375 received Cloxacillin (pre-intervention group) and 205 received Cefuroxime (intervention group). Primary endpoint was the incidence of surgical site infection (SSI) 12 months after surgery, while secondary endpoints were the need for reoperation due to SSI, the amount antibiotics used and the number of visits in the outpatient clinic related to SSI. A control group from another institution was reviewed to rule out clinical trial effects. Results When analysed by intention to treat, the pre-intervention group had a significant higher incidence of SSI, 13.3% (50/375) vs 5.4% (11/205) in the intervention group (p < 0.01). A treatment per protocol analysis confirmed the result. The number of reoperations due to SSI were significantly reduced in the intervention group, 3.4% (7/205) vs 8.3% (31/375) (p = 0.02), as was the total antibiotic use (p = 0.03) and the number of visits in the outpatient clinic (p < 0.01). In the control group, the reoperation rate as result of SSI was lower (p = 0.02) prior to the opposite change from Cefuroxime to Cloxacillin, 1.8% (27/1529) vs 3.1% (43/1378). Conclusion In Sweden, Cefuroxime as prophylaxis in brain tumour surgery by craniotomy seems to be superior to Cloxacillin. Keywords Antibiotic prophylaxis . Neurosurgery . Craniotomy . Surgical site infection . Cefuroxime . Cloxacillin,
Ann-Christin von Vogelsang and Petter Förander contributed equally to this work. This article is part of the Topical Collection on Infection * Simon Skyrman [email protected] 1
Department of Neurosurgery, Karolinska University Hospital, 171 76 Stockholm, Sweden
2
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
3
Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
4
Department of Clinical Neuroscience and Department of Medicine, Karolinska Institutet, Stockholm, Sweden
5
Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
6
Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Box 430, 40530 Gothenburg, Sweden
Introduction Surgical site infection (SSI) is a serious threat to neurosurgical patients causing increased morbidity and mortality [1, 23], with a reported risk ranging from
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