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Single-dose antibiotic prophylaxis compared with multiple-dose protocol in clean pediatric neurosurgical

Esmaeil Mohammadi1, Sina Azadnajafabad1,2, Mehrdad Goudarzi3

  • 11Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran.

Journal of Neurosurgery. Pediatrics
|December 3, 2021
PubMed

Insights

For pediatric neurosurgery, single-dose antimicrobial prophylaxis (AMP) is as effective as multiple-dose AMP. This study found no significant benefit of multiple doses, suggesting single-dose AMP is sufficient and avoids unnecessary antibiotic exposure.

Area of Science:

  • Neurosurgery
  • Pediatric Medicine
  • Infectious Disease Prevention

Background:

  • Current guidelines recommend antimicrobial prophylaxis (AMP) for clean neurosurgical procedures.
  • The optimal dosing strategy (single vs. multiple doses) for AMP in pediatric neurosurgery remains debated.
  • This study addresses the controversy surrounding multiple-dose AMP in pediatric cranial and spinal surgeries.

Purpose of the Study:

  • To compare the efficacy of single-dose versus multiple-dose antimicrobial prophylaxis (AMP) in pediatric neurosurgery.
  • To evaluate surgical site infection rates between single-dose and multiple-dose AMP cohorts.
  • To determine if multiple-dose AMP offers a significant benefit over single-dose AMP in pediatric cranial and spinal surgeries.

Main Methods:

  • Retrospective analysis of 300 pediatric neurosurgery patients (28 days to 18 years) at a single tertiary center.
  • Propensity score matching created three 50-patient arms for single-dose and multiple-dose AMP in noninstrumented spinal, noninstrumented cranial, and instrumented cranial surgeries.
  • Logistic regression analysis adjusted for etiology was used to compare outcomes, with equivalence analysis using a prior meta-analysis.

Main Results:

  • No statistically significant difference in surgical site infections was observed between single-dose and multiple-dose AMP groups across all cohorts.
  • Equivalence analysis showed non-discriminating results for the total cohort (adjusted OR 0.65) and subcohorts (ORs ranging from 0.52 to 0.68).
  • No statistically significant intercohort differences were found based on etiology or surgical procedure type.

Conclusions:

  • Single-dose antimicrobial prophylaxis (AMP) is as effective as multiple-dose AMP in pediatric neurosurgery.
  • There is no detected significant benefit of using multiple-dose AMP over single-dose AMP for clean cranial and spinal neurosurgical interventions.
  • To minimize unnecessary antibiotic exposure, single-dose AMP is indicated for pediatric neurosurgical procedures.
Abstract

Keywords:
antibioticequivalence trialneurological surgerypediatricprophylaxissurgical site infection

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