Extended sequential intravenous and oral antimicrobial therapy improves cure rate in postoperative intracranial neurosurgical infections: a Spanish multicenter retrospective study
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Víctor Asensi1,2, Carlos Vázquez-Fernández3, Silvia Suárez-Díaz3
1Infectious Diseases-HIV Unit, Hospital Universitario Central de Asturias, Avenida de Roma s/n, Oviedo, 33011, Spain. vasensia@gmail.com.
Background:
Postoperative intracranial neurosurgical infections (PINI) complicate < 5% neurosurgeries. Scarce attention was dedicated to the extension and characteristics of its antimicrobial management considering their high morbidity, not negligible mortality, delayed hospital stay and increased healthcare costs.
Methods:
We analyzed retrospectively (2014-2023) 162 PINI from eight Spanish third-level academic hospitals.
Results:
Elective clean craniotomies after tumor or vascular causes were the leading procedures. Epidural abscess (24.7%), scalp infections (19.8%), postsurgical meningitis (16.7%) and cranioplasty infections (16.7%) were the most frequent PINI. Gram negative bacteria (38.6%) and Staphylococcus spp (28.6%) were the predominant isolates. Overall 85.2% patients underwent pus drainage, mostly by craniotomy (40.3%). Interestingly 34% were already receiving antibiotics for extracranial infections before developing PINI while 16.8% did not receive pre-operative antibiotic prophylaxis. In total 77.2% patients started a combined intravenous (IV) antimicrobial therapy, of which 85.2% switched after 5 days to a second-line IV antibiotic regimen, in 41.3% cases combined, after pus culture results, for a median of 21 days. Overall 61.1% patients continued on oral antimicrobials after hospital discharge, 30.3% as a combined regimen, for a median of 42 days. Complete cure was obtained in 81.5% cases, while 11.1% relapsed, 7.4% failed to cure and 6.8% died after PINI complications. In the multivariate analysis oral antimicrobial therapy after hospital discharge (p = 0.001) was significantly associated with PINI cure with no effect on survival.
Conclusions:
We conclude that an extended 6 weeks sequential IV and oral antimicrobial therapy in addition to neurosurgical correction increases PINI cure rate with no effect on survival.
Clinical Trial Number:
Not applicable.
Insights
Extended antimicrobial therapy improves outcomes for postoperative intracranial neurosurgical infections (PINI). A 6-week sequential intravenous and oral treatment regimen enhances cure rates for these serious neurosurgical infections.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Pharmacology
Background:
- Postoperative intracranial neurosurgical infections (PINI) are infrequent but serious complications.
- PINI contribute to significant morbidity, mortality, prolonged hospital stays, and increased healthcare costs.
- Antimicrobial management strategies for PINI require further investigation due to their impact.
Purpose of the Study:
- To analyze the characteristics and antimicrobial management of PINI.
- To identify factors associated with cure and survival in patients with PINI.
Main Methods:
- Retrospective analysis of 162 PINI cases from 2014-2023 across eight Spanish academic hospitals.
- Data collected on neurosurgical procedures, infection types, causative pathogens, and antimicrobial treatments.
- Multivariate analysis to determine factors influencing PINI cure and survival.
Main Results:
- Common PINI include epidural abscess, scalp infections, meningitis, and cranioplasty infections.
- Gram-negative bacteria and Staphylococcus spp. were the predominant pathogens.
- An extended 6-week sequential intravenous and oral antimicrobial therapy was associated with increased cure rates (81.5%) but not survival.
Conclusions:
- Extended antimicrobial therapy, including oral administration post-discharge, is crucial for improving cure rates in PINI.
- Neurosurgical correction combined with prolonged antimicrobial treatment enhances patient recovery.
- While improving cure, extended antimicrobial therapy did not significantly impact survival rates in this cohort.
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