Reduction in the infection rate of cranioplasty with a tailored antibiotic prophylaxis: a nonrandomized study
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ORIGINAL ARTICLE - INFECTION
Reduction in the infection rate of cranioplasty with a tailored antibiotic prophylaxis: a nonrandomized study Igor Paredes 1 & Alfonso Lagares 1 & Rafael San-Juan 2 & Ana María Castaño-León 1 & Pedro-Antonio Gómez 1 & Luis Jimenez-Roldán 1 & Irene Panero 1 & Carla Eiriz 1 & Daniel García-Perez 1 & Luis Miguel Moreno 1 & Angel Perez-Nuñez 1 & Pedro Gonzalez-León 1 & José Antonio F. Alén 1 Received: 30 April 2020 / Accepted: 20 July 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 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.
This article is part of the Topical Collection on Infection * Igor Paredes [email protected]; [email protected]
Daniel García-Perez [email protected] Luis Miguel Moreno [email protected]
Alfonso Lagares [email protected] Rafael San-Juan [email protected]
Angel Perez-Nuñez [email protected]
Ana María Castaño-León [email protected]
Pedro Gonzalez-León [email protected]
Pedro-Antonio Gómez [email protected]
José Antonio F. Alén [email protected]
Luis Jimenez-Roldán [email protected] Irene Panero [email protected] Carla Eiriz [email protected]
1
Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain
2
Unit of Infectious Diseases, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain
Acta Neurochir
Keywords Cranioplasty infection rate . Surgical site infe
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