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Comparing Rates of Postoperative Meningitis After Endoscopic Endonasal Procedures Based on Methicillin-Resistant
Cordelia Orillac1, Aneek Patel1, Yosef Dastagirzada1
1Department of Neurosurgery, NYU Langone Health, New York, New York, USA.
Background:
Endoscopic endonasal approach (EEA) procedures are inherently contaminated due to direct access through the nasopharyngeal mucosa. The reported rate of postoperative meningitis in EEA procedures is 0.7%-3%. A variety of methods exist to minimize the risk of meningitis with antibiotic prophylaxis, although their value is not completely understood. This study investigated whether there is a difference in rates of postoperative meningitis based on Staphylococcus aureus colonization and use of preoperative antibiotic prophylaxis.
Methods:
All adult patients who underwent EEA resection at our institution from 2013 to 2021 were retrospectively reviewed. Patients with preoperative cerebrospinal fluid infections were excluded. Data including recent preoperative infections, preoperative colonization status, antibiotic administration, and postoperative outcomes were recorded for each patient.
Results:
Of 483 patients identified (mean age, 51 years; range, 18-90 years; 274 [56.7%] female), 80 (16.6%) had a positive preoperative methicillin-resistant Staphylococcus aureus (MRSA)/methicillin-sensitive Staphylococcus aureus (MSSA) screening swab. Twenty-one (26.3%) colonized patients were treated with preoperative decolonizing antibiotics. Within 30 days of surgery, 13 (2.7%) patients developed culture-positive meningitis. There was no significant difference in meningitis rates based on MRSA/MSSA colonization status. Among colonized patients, there was no significant difference in rates of MRSA/MSSA meningitis based on preoperative antibiotic decolonization.
Conclusions:
Postoperative rates of meningitis after EEA surgery were not significantly changed based on MRSA/MSSA colonization status of the patient or preoperative decolonization. The utility of preoperative testing of MRSA/MSSA status and antibiotics for decolonization to prevent postoperative meningitis should be further investigated.
Insights
Postoperative meningitis rates after endoscopic endonasal approach surgery were not significantly affected by Staphylococcus aureus colonization or antibiotic decolonization. Further research is needed to determine the utility of these interventions for preventing meningitis.
Area of Science:
- Neurosurgery
- Infectious Disease
- Otolaryngology
Background:
- Endoscopic endonasal approach (EEA) procedures carry a risk of postoperative meningitis (0.7%-3%) due to nasopharyngeal mucosa contamination.
- Preoperative antibiotic prophylaxis is used to mitigate this risk, but its effectiveness is not fully understood.
Purpose of the Study:
- To investigate the impact of Staphylococcus aureus colonization and preoperative antibiotic prophylaxis on postoperative meningitis rates following EEA procedures.
- To determine if MRSA/MSSA screening and decolonization influence meningitis incidence.
Main Methods:
- Retrospective review of 483 adult patients undergoing EEA resection from 2013-2021.
- Exclusion of patients with preoperative cerebrospinal fluid infections.
- Data collection on preoperative infections, colonization status, antibiotic use, and outcomes.
Main Results:
- 16.6% of patients had positive Staphylococcus aureus (MRSA/MSSA) screening.
- 2.7% of all patients developed culture-positive meningitis within 30 days.
- No significant difference in meningitis rates was found based on colonization status or preoperative decolonization.
Conclusions:
- Patient colonization with MRSA/MSSA and preoperative antibiotic decolonization did not significantly alter postoperative meningitis rates after EEA.
- The value of preoperative MRSA/MSSA screening and decolonization for meningitis prevention warrants further investigation.
