Effect of Staphylococcal Decolonization Regime on Post-Craniotomy Meningitis

Post craniotomy meningitis (PCM), an uncommon complication following craniotomy can be categorized as either bacterial meningitis (BM) or aseptic meningitis (AM) based on the results of CSF culture. Staph. aureus is a common causative organism. Some patients who are nasal carriers of these organisms have been shown to be at a higher risk of acquiring surgical site infections (SSI) following general or gynecological surgeries. Staphylococcal decolonization regime (SDR), using chlorhexidine gluonate (CHG) showers and application of mupirocin ointment to the anterior nares, is an attempt to reduce the load of these bacteria in a patient prior to surgery. SDR targeted at those proven to be nasal carriers of staphylococcal bacteria, has shown to reduce SSI following general surgery, gynecological surgery and cardio-thoracic surgery. However, its effectiveness in reducing PCM has been poorly investigated. In a review of the literature on the use of SDR in patients undergoing craniotomy, we found only one study where the authors used CHG showers but in a non-targeted fashion (all patients rather than only carriers). They showed a reduction in the incidence of both AM and BM following craniotomy compared to historical controls, but the study had a confounder in the form of a change of the prophylactic antibiotic used. While there is no high quality evidence that SDR is effective in reducing PCM, its relatively low cost, easy implementation and few and mild side effects, would make it attractive to adopt in patients undergoing craniotomy.