Antibiotic prophylaxis for subdural and subgaleal drains

Area of Science:

• Neurosurgery
• Infectious Diseases
• Pharmacology

Background:

• Prolonged prophylactic systemic antibiotics (PPSAs) are commonly used after cranial surgery with subdural or subgaleal drains.
• The necessity and impact of PPSAs on infection rates and antibiotic resistance are not fully understood.

Purpose of the Study:

• To evaluate the effect of discontinuing PPSAs on surgical site infections (SSIs) in patients with subdural and subgaleal drains.
• To assess the impact on Clostridium difficile infections (CDI) and the development of resistant bacteria.

Main Methods:

• Retrospective analysis of patients aged over 17 undergoing cranial surgery.
• Data collected from two periods: one with PPSAs (Dec 2013-Jul 2014) and one without (Dec 2014-Jul 2015).
• Comparison of SSI rates, CDI frequency, and resistant organism growth between the two periods.

Main Results:

• Discontinuation of PPSAs did not lead to an increase in SSI frequency.
• A significant reduction in CDI and the growth of resistant bacteria was observed after stopping PPSAs.
• Cost savings of $93,194.63 were achieved in 8 months due to reduced antibiotic use and complications.

Conclusions:

• Patients with subdural or subgaleal drains can safely forgo prolonged prophylactic systemic antibiotics.
• Limiting antibiotic use to 24 hours post-surgery avoids complications and reduces CDI and resistant organism development.
• This practice change offers clinical benefits and significant cost savings.