Reduction in the infection rate of cranioplasty with a tailored antibiotic prophylaxis: a nonrandomized study.
Acta Neurochir (Wien)
; 162(11): 2857-2866, 2020 11.
Article
em En
| MEDLINE
| ID: mdl-32720014
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.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Infecções Estafilocócicas
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Infecção da Ferida Cirúrgica
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Antibioticoprofilaxia
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Procedimentos Neurocirúrgicos
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Procedimentos de Cirurgia Plástica
Tipo de estudo:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Acta Neurochir (Wien)
Ano de publicação:
2020
Tipo de documento:
Article
País de afiliação:
Espanha