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Increased Risk of Surgical Site Infections With Clindamycin Prophylaxis in Clean Craniotomy.

Samuel Latreille1, Rémy Bernard1, Antoine Abi Lutfallah1

  • 1Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris , France.

Neurosurgery
|September 9, 2025
PubMed
Summary

Clindamycin increases surgical site infection risk in clean craniotomy patients. Cefazolin remains the preferred antibiotic for preventing postoperative central nervous system infections.

Keywords:
Antibiotic prophylaxisCefazolinClindamycinCraniotomySurgical site infections

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Area of Science:

  • Neurosurgery
  • Infectious Disease Epidemiology
  • Clinical Pharmacy

Background:

  • Postoperative central nervous system infections are a significant complication after craniotomy, with incidence rates between 2.2% and 9.6%.
  • Preoperative antibiotic prophylaxis, particularly cephalosporins like cefazolin, is standard for reducing these infections.
  • Alternative antibiotics like vancomycin or clindamycin are used for penicillin-allergic patients, but their efficacy is debated, with some studies linking clindamycin to increased surgical site infections (SSI).

Purpose of the Study:

  • To evaluate the impact of clindamycin compared to cefazolin on the incidence of surgical site infections (SSI) in patients undergoing clean craniotomy.
  • To identify independent risk factors for SSI in this patient population.

Main Methods:

  • Retrospective analysis of a prospective surveillance database (2005-2020) of patients undergoing clean craniotomy.
  • Inclusion of 12,347 patients, comparing cefazolin and clindamycin prophylaxis groups.
  • Application of univariate, multivariate, and propensity score matching analyses to assess SSI risk.

Main Results:

  • The overall SSI rate was 2.45%. Clindamycin use was significantly associated with a higher risk of SSI (aOR: 2.52) and 90-day revision for infection (OR: 2.09).
  • Propensity score analysis confirmed increased SSI rates (OR: 2.59) and revision for infection with clindamycin.
  • Independent SSI risk factors included male sex, high ASA score, prolonged surgery, specific diagnoses, and cerebrospinal fluid leakage (aOR: 38.51).

Conclusions:

  • Clindamycin prophylaxis is linked to an elevated risk of SSI in clean craniotomy procedures.
  • Cefazolin is recommended as the preferred antibiotic due to its safety profile and efficacy, even in penicillin-allergic patients.
  • Prospective evaluation of prophylaxis protocols is needed to optimize postoperative infection prevention strategies.