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Published on: July 5, 2021
Ultra-short antibiotic prophylaxis guided by preoperative microbiological nasal swabs in endoscopic endonasal skull
M Ceraudo1, A Prior2, A Balestrino2
1Division of Neurosurgery, San Martino- IST University Hospital (IRCCS), Genoa, Italy. ceraudom91@gmail.com.
Purpose:
Endoscopic endonasal skull base surgery (EESBS) is a clean-contaminated procedure. Guidelines regarding the antibiotic prophylaxis in EESBS have not been developed yet, and today, there are no universally accepted protocols. In this article, we investigated the efficacy of our new ultra-short antibiotic prophylaxis protocol for EESBS guided by the cultural results of preoperative microbiological nasal swabs.
Methods:
We defined as "nasal swab-related antibiotic protocol" the administration of a first-generation cephalosporin (cefazolin 2 g) in patients whose nasal swabs revealed the presence of normal nasal flora or methicillin-sensitive Staphylococcus aureus (MSSA), and the administration of vancomycin 1 g intravenously in patients whose nasal swabs revealed the presence of methicillin-resistant Staphylococcus aureus (MRSA) or with reported cephalosporin/penicillin allergy. This case-control study included 120 patients who underwent EESBS. The case group included 60 cases who received the "nasal swab-related antibiotic protocol," while the control group included 60 cases who received the "standard hospital antibiotic protocol" used in neurosurgery (cefazolin 2 g plus metronidazole 500 mg at induction, and 2 g of cefazolin repeated after 180 min).
Results:
The preoperative microbiological nasal swabs showed normal nasal flora in 42 patients (70%), MSSA in 17 patients (28.3%), and MRSA in 1 patient (1.6%). During the study period, no cases of meningitis or sinusitis occurred in the case group ("nasal swab-related antibiotic protocol"), while two infections (3.3%, 1 sinusitis and 1 meningitis) were reported in the control group ("standard hospital antibiotic protocol"). Mean length of hospitalization was 6.5 days for the case group and 8.5 days in the control group. "Standard hospital antibiotic protocol" is less expensive (range, 2.88-5.42 euros) compared with our new "nasal swab-related antibiotic protocol" (range, 10.02-32.56 euros), but in line with other antibiotic prophylaxis protocols reported in literature.
Discussion:
The low complication rates of our case series (0%) is comparable to complication rates reported in literature (1.6% for meningitis and 8% for sinusitis). Compared with other perioperative antibiotic regimens reported in literature, the "nasal swab-related antibiotic protocol" is cheap and at least equally effective. We discuss the rationale on which we based the choice of chemoprophylaxis, the timing, and the length of our regimen.
Conclusions:
Our study confirmed the safety and efficacy of our easily applicable and low-cost antibiotic prophylaxis protocol.
Insights
This study demonstrates a new, personalized antibiotic prophylaxis protocol for endoscopic endonasal skull base surgery (EESBS). Tailoring antibiotics based on nasal swab cultures significantly reduces infection rates and hospitalization duration in EESBS patients.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Pharmacology
Background:
- Endoscopic endonasal skull base surgery (EESBS) is a clean-contaminated procedure.
- Current antibiotic prophylaxis guidelines for EESBS are lacking, leading to non-standardized protocols.
- The need for effective, evidence-based antibiotic strategies in EESBS is critical.
Purpose of the Study:
- To investigate the efficacy of a novel, ultra-short antibiotic prophylaxis protocol for EESBS.
- To evaluate a protocol guided by preoperative microbiological nasal swab cultures.
- To compare the outcomes of this new protocol against a standard hospital protocol.
Main Methods:
- A case-control study involving 120 patients undergoing EESBS.
- The 'nasal swab-related antibiotic protocol' involved targeted antibiotic administration based on nasal swab results (cefazolin for normal flora/MSSA, vancomycin for MRSA/allergy).
- The control group received a standard neurosurgery antibiotic protocol (cefazolin and metronidazole).
Main Results:
- No infections (meningitis or sinusitis) occurred in the group using the nasal swab-related protocol (0%).
- The control group experienced two infections (3.3%), including one sinusitis and one meningitis.
- The nasal swab-related protocol group had a shorter mean hospitalization (6.5 days vs. 8.5 days).
Conclusions:
- The personalized, nasal swab-guided antibiotic prophylaxis protocol is safe and effective for EESBS.
- This easily applicable and low-cost protocol demonstrates comparable or superior efficacy to standard regimens.
- The findings support the adoption of targeted antibiotic prophylaxis in EESBS to minimize complications.
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