Retrospective analysis of a new antibiotic chemoprophylaxis regimen in 170 patients undergoing endoscopic endonasal transsphenoidal surgery

Orlando, Raffaele; Cappabianca, Paolo; Tosone, Grazia; Esposito, Felice; Piazza, Marcello; Divitiis, Enrico de

doi:10.1016/j.surneu.2006.10.063

Cited by 33 publications

(39 citation statements)

References 24 publications

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“…Orlando et al reviewed their experience with 170 patients treated with amikacin and ceftazidine for a mean of 3 days and noted one case of meningitis (0.6%) and one case of sinusitis (0.6%) [8]. Brown et al reviewed 90 cases of endonasal surgery from a prospectively maintained database of patients treated with cefazolin for 24-48 h [1].…”

Section: Discussionmentioning

confidence: 99%

Prophylactic antibiotic trends in transsphenoidal surgery for pituitary lesions

Little

White

2010

Pituitary

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Pituitary surgery involves operating in the nasal cavity, which is considered a clean-contaminated wound. In the absence of evidence-based guidelines for preventing surgical site infections in trans-sphenoidal surgery, a survey of current opinion on prophylactic antibiotics might help elucidate the current acceptable practices and identify opportunities for prospective clinical trials that could lead to the development of practice guidelines. An on-line, 10-question, multiple-choice survey was distributed by e-mail link to the membership of the International Society of Pituitary Surgeons. Sixty-nine members responded to the survey. Ninety-one percent indicated that there was no strong evidence supporting antibiotic use, but 81% used them to be safe. Ninety percent of respondents used intravenous prophylactic antibiotics, while only 16% used intranasal antibiotics. The most commonly used antibiotics were cephalosporins (72%) and penicillins (21%). Seventy-six percent used antibiotics for 24 h or less after surgery. The most commonly reported indications for prophylactic antibiotics were prevention of meningitis and sinusitis. The results of the survey describe current acceptable practices for chemoprophylaxis in patients undergoing transsphenoidal pituitary surgery.

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Section: Discussionmentioning

confidence: 99%

Prophylactic antibiotic trends in transsphenoidal surgery for pituitary lesions

Little

White

2010

Pituitary

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“…Brown et al [9] demonstrated no cases of meningitis in 90 patients using cefazolin for a total duration of 24-48 h. Orlando et al [10] reported one case of meningitis in 170 patients treated with amikacin and ceftazidime for a mean of 3 days. Our study supplements these works in several important ways.…”

Section: Discussionmentioning

confidence: 99%

“…Since both approaches transgress the same anatomy, this antibiotic regimen is probably also applicable to endoscopic work, although this issue was not studied directly. The studies by Orlando et al [10] and Brown et al [9] were conducted in patients undergoing endoscopic approaches and their rates of meningitis were low.…”

Section: Discussionmentioning

confidence: 99%

Short-duration, single-agent antibiotic prophylaxis for meningitis in trans-sphenoidal surgery

Little

White

2011

Pituitary

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Perioperative bacterial meningitis after trans-sphenoidal surgery for pituitary and parasellar lesions is an uncommon but serious complication. Little evidence guides the choice of chemoprophylaxis in this setting. To begin to address this deficiency, we investigated the incidence of perioperative meningitis in 442 patients who underwent trans-sphenoidal surgery and received a short chemoprophylaxis regimen with a single agent and did not require lumbar drainage. In 2005 we instituted a standardized antibiotic prophylaxis protocol for trans-sphenoidal surgery that utilized intravenous cefuroxime, a second-generation cephalosporin with broad coverage and excellent spinal fluid penetration, administered 30 min before surgery and 8 h later. The primary endpoint was the incidence of perioperative (within 30 days of surgery) bacterial meningitis. Data from The Barrow Pituitary Outcomes Project, a prospectively maintained patient research database, were supplemented with review of medical records and hospital discharge codes. There were no cases of perioperative meningitis. Three patients developed delayed meningitis associated with persistent or recurrent spinal fluid leakage 2-8 months after surgery. Perioperatively, seven patients received additional antibiotics for urinary tract infections. A single-agent, short-duration chemoprophylaxis regimen for trans-sphenoidal surgery is effective at preventing perioperative meningitis in patients who do not require lumbar drainage after surgery. The results of this regimen compare favorably to historical rates achieved with longer regimens that use two antibiotics. Future studies will investigate the role prophylactic antibiotics play in nasal mucosa healing and sinusitis.

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“…No cases of intracranial infections or meningitis were reported. 26 Orlando et al 27 reported a retrospective cohort of 170 patients who, between January 1997 and July 2001, underwent endoscopic transsphenoidal surgery. Twenty-four of the 170 patients in the study underwent an intradural surgery, with entry into the subarachnoid space and intraoperative CSF leak.…”

Section: Descriptionmentioning

confidence: 99%

“…Asymptomatic sphenoid sinusitis was diagnosed in two other patients. 27 Given the paucity of data in the endoscopic skull base literature, we elected to also examine craniofacial resections and open approaches to skull base pathology by performing the search without the "endoscopic" restriction. Two studies were included from the open skull base literature.…”

Section: Descriptionmentioning

confidence: 99%

Systematic Review of the Effectiveness of Perioperative Prophylactic Antibiotics for Skull Base Surgeries

Rosen

Getz²,

Kingdom³

et al. 2016

Am J Rhinol�Allergy

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Despite institutional variability in antibiotic regimens, meningitis rarely occurs after skull base procedures and seems to be encountered most frequently in open craniofacial surgeries. A systematic review revealed a limited number of published studies, all observational in study design, which precluded a formal meta-analysis. A novel large-scale randomized-controlled clinical trial is needed to evaluate antibiotic selection and need in endoscopic skull base surgery.

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Retrospective analysis of a new antibiotic chemoprophylaxis regimen in 170 patients undergoing endoscopic endonasal transsphenoidal surgery

Cited by 33 publications

References 24 publications

Prophylactic antibiotic trends in transsphenoidal surgery for pituitary lesions

Prophylactic antibiotic trends in transsphenoidal surgery for pituitary lesions

Short-duration, single-agent antibiotic prophylaxis for meningitis in trans-sphenoidal surgery

Systematic Review of the Effectiveness of Perioperative Prophylactic Antibiotics for Skull Base Surgeries

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