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Prophylactic antibiotic use in closed basilar skull fractures: A nationwide cohort study
Eunji Kim1, Jinwook Hong, Hanbit Shin
1From the Department of Preventive Medicine (E.K., H.S., J.Y.M.), Gachon University College of Medicine; Artificial Intelligence and Big-Data Convergence Center (E.K., H.S.), Gil Medical Center; Health Information Technology Research Center (J.H., J.Y.M., W.S.), and Department of Otorhinolaryngology (W.S.), Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
Background:
The effectiveness of prophylactic antibiotics for preventing meningitis in patients with closed basilar skull fractures remains controversial. This nationwide cohort study aimed to evaluate the association between prophylactic antibiotic use and the incidence of meningitis in patients with closed basilar skull fractures using Korean national claims data.
Methods:
A retrospective cohort study was conducted with basilar skull fractures between 2002 and 2019 using International Classification of Diseases, Tenth Revision , code S021. Data were obtained from the National Health Insurance Service sample cohort database in South Korea. The primary outcome was the cumulative incidence of meningitis following closed basilar skull fractures, and those with open fractures or those who underwent surgery during hospitalization were excluded.
Results:
Of the 1,173 patients included, 537 (45.8%) received prophylactic antibiotics and 636 (54.2%) did not. Patients who received antibiotics were significantly older and had higher rates of intensive care unit admission. Antibiotic use was more common in the elderly group (65 years or older) compared with pediatric (younger than 18 years) and adult (18-64 years) groups. Among those who received antibiotics, 15 cases of meningitis (2.6%) were reported, with no clear association between the type or duration of antibiotic and meningitis occurrence. The cumulative incidence of meningitis was extremely low in both groups, and there was no statistically significant difference in meningitis risk between the antibiotic and non-antibiotic groups across all observation periods. Adjusted hazard ratios indicated no significant association between antibiotic use and meningitis risk, and this finding was consistent in subgroup analyses by age.
Conclusion:
This study found no significant association between prophylactic antibiotic use and reduced risk of meningitis in patients with closed basilar skull fractures. These findings suggest that routine prophylactic antibiotic administration may not provide additional benefits in preventing meningitis.
Level Of Evidence:
Therapeutic/Care Management; Level III.
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