Prophylactic antibiotics in pediatric neurological surgery

Knerlich-Lukoschus, Friederike; Messing‐Jünger, Martina

doi:10.1007/s00381-018-3864-0

Cited by 7 publications

(8 citation statements)

References 55 publications

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“…Contrarily to most of the other surgical procedures, shunt procedures have been studied in the pediatric population. Pediatric neurosurgeons suggest cefazolin as the drug of choice, with vancomycin or clindamycin as alternative in case the procedure is performed in areas with high MRSA circulation [ 76 ].…”

Section: Resultsmentioning

confidence: 99%

Surgical Antimicrobial Prophylaxis in Neonates and Children Undergoing Neurosurgery: A RAND/UCLA Appropriateness Method Consensus Study

et al. 2022

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Pediatric neurosurgery is a highly specialized branch of surgery in which surgical site infections (SSIs) are potentially serious complications that can also adversely affect a good surgical outcome, compromising functional recovery and, in some cases, even putting the patient’s life at risk. The main aim of this consensus document is to provide clinicians with a series of recommendations on antimicrobial prophylaxis for neonates and children undergoing neurosurgery. The following scenarios were considered: (1) craniotomy or cranial/cranio-facial approach to craniosynostosis; (2) neurosurgery with a trans-nasal-trans-sphenoidal approach; (3) non-penetrating head injuries; (4) penetrating head fracture; (5) spinal surgery (extradural and intradural); (6) shunt surgery or neuroendoscopy; (7) neuroendovascular procedures. Patients undergoing neurosurgery often undergo peri-operative antibiotic prophylaxis, with different schedules, not always supported by scientific evidence. This consensus provides clear and shared indications, based on the most updated literature. This work has been made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies, and represents, in our opinion, the most complete and up-to-date collection of recommendations on the behavior to be held in the peri-operative setting in this type of intervention, in order to guide physicians in the management of the patient, standardize approaches and avoid abuse and misuse of antibiotics.

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Section: Resultsmentioning

confidence: 99%

Surgical Antimicrobial Prophylaxis in Neonates and Children Undergoing Neurosurgery: A RAND/UCLA Appropriateness Method Consensus Study

et al. 2022

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“…Prolonged and inappropriate prophylactic antibiotics have been associated with the occurrence of nosocomial infections and the development of multidrugresistant organisms. 1,[19][20] For outcomes of SSI patients in this study, one expired due to post-operative complications, accounting for a 5.6% SSI-related mortality. The relatively higher rate, compared to 3% as described in other large sample studies, can be attributed to the smaller sample size used in the study.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical site infections (SSI) are one of the most feared hospital-acquired infections in neurosurgery because of their potentially serious consequences and complications and increased morbidity & mortality. 1 SSI is associated with a 3% mortality rate, 75% of which are directly attributable to infection. It is also the most expensive type of hospital-acquired infection with an estimated annual expense of 3.3 billion US dollars.…”

Section: Introductionmentioning

confidence: 99%

“…Evidence-based recommendations on the use of SAP are still lacking, especially in clean neurosurgeries, where risk of infection is reported to be low (1-2%). 1,4 Current guidelines in the pediatric population were largely derived from adult neurosurgical studies. 1 One study by Korinek, et al.…”

Section: Introductionmentioning

confidence: 99%

“…1,4 Current guidelines in the pediatric population were largely derived from adult neurosurgical studies. 1 One study by Korinek, et al. concluded that prophylaxis is effective in preventing SSI in low risk patients.…”

Section: Introductionmentioning

confidence: 99%

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The Association of Adherence to Antimicrobial Prophylactic Recommendations for Clean Neurosurgeries with Post-operative Surgical Site Infection

Ho¹,

Ong-Lim²

2022

PIDSPJ

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Objective: The use of antimicrobial prophylaxis to prevent surgical site infections (SSI) is well established. This study examined the association of adherence to antimicrobial prophylaxis for clean neurosurgeries with post-operative surgical site infection (SSI) rates. Methods: A retrospective descriptive study was conducted at the Philippine General Hospital (PGH) among pediatric patients who underwent clean neurosurgical procedures between January 1, 2018 – December 31, 2019. The outcome measured was the development of SSI. Univariate and multivariate analysis was performed to show the association of risk factors with SSI. Compliance to existing antibiotic prophylaxis recommendation was assessed. Results: One hundred eighty-nine (189) medical charts were reviewed. Overall prevalence of SSI was 9.5% and fever was the most common initial symptom of SSI. Staphylococcus species was identified from cultures of surgical sites, consistent with existing literature, however gram-negative organisms including multidrug-resistant organisms (MDRO) were noted. All cases received prophylactic antibiotics, but adherence to all parameters (antimicrobial choice, dose, timing, route, re-dosing and duration of prophylaxis) was low at 7.9%. Appropriate antibiotics were prescribed in only 15.9% and antibiotics were discontinued beyond 24 hours post-surgery in 45.5% of cases. Patients who received a regimen fully compliant with antimicrobial prophylaxis recommendations did not develop SSI. Conclusion: Adherence to existing antimicrobial prophylaxis protocol for neurosurgeries is low at 7.9%. Patients who received a regimen fully compliant with the recommendations did not develop SSI. Interventions to improve compliance to antimicrobial prophylaxis guidelines are needed.

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Placement of EVD in pediatric posterior fossa tumors: safe and efficient or old-fashioned? The Vienna experience

et al. 2023

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Purpose The perioperative treatment of hydrocephalus in pediatric posterior fossa tumors with an external ventricular drain (EVD) is the treatment of choice in our center. We analyzed our experience in using EVD concerning safety and effectivity. Methods This is a single-center retrospective cohort study of 100 consecutive pediatric patients who underwent resection for a newly diagnosed tumor in the posterior fossa between 2011 and 2022. Results Of the 100 patients with posterior fossa tumors, 80 patients (80%) had radiological signs of hydrocephalus at presentation, 49 patients (49%) of whom underwent placement of an EVD. In 40 patients, the EVD was inserted at a mean of 2.25 days prior to the tumor resection; 9 had the EVD inserted during tumor resection (frontal trajectory in 7 patients, occipital trajectory in 2 patients). Histology revealed pilocytic astrocytoma in 48 patients, medulloblastoma in 32, ependymoma in 11, and other histologic entities in 9 patients. Gross total/near-total resection was achieved in 46 (95.83%) of the 48 pilocytic astrocytomas, 30 (93.75%) of the 32 medulloblastomas, and 11 (100%) of the 11 ependymomas. The mean number of total days with the EVD in place was 8.61 ± 3.82 (range 2–16 days). The mean number of days with an EVD after tumor resection was 6.35 ± 3.8 (range 0–16 days). EVD-associated complications were seen in 6 patients (12.24%) including one infection. None of these resulted in a worse clinical course or any long-term sequelae. Permanent CSF diversion at 6 months after surgery was necessary in 13 patients (13%), including two VP shunt, two SD-shunt, six endoscopic third ventriculostomy (ETV), and three combined VP shunt and ETV procedures. Patients with a medulloblastoma or ependymoma had a higher rate of permanent CSF diversion needed than the group of pilocytic astrocytoma patients (27.9% versus 2.13%, p < 0.001). In patients with metastatic disease, 7 of 17 patients (41.18%) needed a permanent CSF diversion, compared to 6 of 83 patients (7.23%) in the group without metastasis (p = 0.001). Conclusion The treatment of hydrocephalus in pediatric posterior fossa tumors with an EVD as a temporary measure is safe and effective, provided that a multi-professional understanding for its handling is given and there is no need for a long transport of the children.

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Prophylactic antibiotics in pediatric neurological surgery

Abstract: Due to statistical needs, multi-center surveillance studies are needed for implementing SAP recommendations in pediatric neurosurgery.

Cited by 7 publications

References 55 publications

Surgical Antimicrobial Prophylaxis in Neonates and Children Undergoing Neurosurgery: A RAND/UCLA Appropriateness Method Consensus Study

Surgical Antimicrobial Prophylaxis in Neonates and Children Undergoing Neurosurgery: A RAND/UCLA Appropriateness Method Consensus Study

The Association of Adherence to Antimicrobial Prophylactic Recommendations for Clean Neurosurgeries with Post-operative Surgical Site Infection

Placement of EVD in pediatric posterior fossa tumors: safe and efficient or old-fashioned? The Vienna experience

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