Surgical Antimicrobial Prophylaxis in Neurosurgery: A Nationwide Survey on Guideline Adherence in Türkiye

Surgical antimicrobial prophylaxis (SAP) is a key strategy for preventing surgical site infections (SSIs), yet its implementation in clinical practice remains variable despite established guideline recommendations. This study aimed to assess neurosurgeons' knowledge and practices regarding SAP in Türkiye and to evaluate their adherence to current guideline recommendations.

This multicenter, cross-sectional study was conducted among actively practicing neurosurgeons across Türkiye using an online survey. A structured questionnaire, informed by relevant national and international guidelines collected data on demographic characteristics and key aspects of SAP, including antibiotic selection, timing of initiation, dosing strategies, and duration of prophylaxis. Categorical variables were analyzed using the chi-square test, and a p-value < 0.05 was considered statistically significant.

A total of 464 participants were included. Overall,30.2% of respondents rated their SAP knowledge as "good," ranging from 21.9% among residents to 80% among professors (p < 0.001). Guideline-concordant antibiotic selection was reported by 70.7% of participants; however, in cranial procedures, ceftriaxone was preferred over cefazolin in 50.9% of cases. Adherence to the recommended timing of prophylaxis initiation was reported by 62% of participants, while 68.1% administered additional intraoperative doses during prolonged surgeries. Only 51.7% considered patient body weight when adjusting doses, and 37.9% discontinued prophylaxis within 24 hours postoperatively. Professors demonstrated higher adherence across several parameters, including initiation timing, dosing, and discontinuation (all p < 0.05).

Adherence to key components of SAP remains suboptimal among neurosurgeons in Türkiye. Although knowledge levels varied across academic ranks, this did not consistently translate into clinical practice. Structured educational initiatives, institutional protocols, and audit-based interventions may help improve adherence to guideline-based SAP practices.

Graphical Abstract.