Risk Factors and Microbiology of Meningitis and/or Bacteremia After Transsphenoidal Surgery for Pituitary Adenoma

Yu, Jiang; Liu, Xiaohai; Gao, Lu; Guo, Xiaopeng; Wang, Qiang; Bao, Xinjie; Deng, Kan; Yao, Yong; Feng, Ming; Lian, Wei; Wang, Renzhi; Yang, Qiwen; Wang, Yao; Xing, Bing

doi:10.1016/j.wneu.2017.11.125

Cited by 22 publications

(19 citation statements)

References 42 publications

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“…8,18,19 Similarly, while we did have a higher incidence of intraoperative CSF leak compared with other studies (40.2 vs. 32.8%) due to inclusion of nonpituitary pathologies with expected intraoperative leaks, this was not associated with increased inpatient or postdischarge infectious complications up to 30 days after surgery (p ¼ 0.896), as it has shown to be in other studies. 8,[18][19][20] These findings support our standardized perioperative antibiotic regimen: cefazolin for 24 hours, followed by cephalexin for 6 days after surgery (clindamycin if penicillin/cephalosporin allergic).…”

Section: Discussionsupporting

confidence: 59%

“…Furthermore, while a review by Patel et al additionally supported antibiotic use for <24 hours in skull base surgery, a more recent review by Jin et al reported higher rates of meningitis and bacteremia (1.8%), and even death from infection (0.4%), among 3,242 patients treated with antibiotic prophylaxis for a total duration of 48 hours after surgery. 9,18 This may support the use of antibiotic prophylaxis for a longer duration after surgery. Overall, our rates of infection are comparable to that of current literature.…”

Section: Discussionmentioning

confidence: 88%

“…While none of these factors were significantly associated with higher risk for infectious complications in our cohort, many of these factors have been shown to increase infectious risk in other studies. 18,20,25 Milanese et al specifically linked intraoperative and postoperative CSF leaks with increased rates of meningitis among 2,032 patients, reporting 1.3% of patients with intraoperative CSF leaks and 10.14% of patients with postoperative CSF leaks suffering from meningitis. 20 Furthermore, this study employs a short-term intraoperative antibiotic prophylaxis regimen that was switched to an ultrashort (single dose) intraoperative antibiotic regimen.…”

Section: Discussionmentioning

confidence: 99%

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Perioperative Antibiotic Use in Endoscopic Endonasal Skull Base Surgery

Nakhla

Villalpando

et al. 2021

J Neurol Surg B Skull Base

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Background Improved evidence-based guidelines on the optimal type and duration of antibiotics for patients undergoing endoscopic endonasal transsphenoidal surgery (EETS) are needed. We analyze the infectious complications among a large cohort of EETS patients undergoing a standardized regimen of cefazolin for 24 hours, followed by cephalexin for 7 days after surgery (clindamycin if penicillin/cephalosporin allergic). Methods A retrospective review of 132 EETS patients from 2018 to 2020 was conducted. Patient, tumor, and surgical characteristics were collected, along with infection rates. Multivariate logistic regression determined the variable(s) independently associated with infectious outcomes. Results Nearly all patients (99%) received postoperative antibiotics with 78% receiving cefazolin, 17% receiving cephalexin, 3% receiving clindamycin, and 2% receiving other antibiotics. Fifty-three patients (40%) had an intraoperative cerebrospinal fluid (CSF) leak, and three patients (2%) developed a postoperative CSF leak requiring surgical repair. Within 30 days, no patients developed meningitis. Five patients (4%) developed sinusitis, two patients (3%) developed pneumonia, and one patient (1%) developed cellulitis at a peripheral intravenous line. Two patients (2%) developed an allergy to cephalexin, requiring conservative management. After adjustment for comorbidities and operative factors, presence of postoperative infectious complications was independently associated with increased LOS (β = 3.7 days; p = 0.001). Conclusion Compared with reported findings in the literature, we report low rates of infectious complications and antibiotic intolerance, despite presence of a heavy burden of comorbidities and high intraoperative CSF leak rates among our cohort. These findings support our standardized 7-day perioperative antibiotic regimen.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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Perioperative Antibiotic Use in Endoscopic Endonasal Skull Base Surgery

Nakhla

Villalpando

et al. 2021

J Neurol Surg B Skull Base

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“…In general, gram-positive coccus (GPC) and gram- negative rod (GNR) frequently cause surgical site infection. 7 , 17 , 18) Hence, in the current analysis, the bacteria were classified into two groups and were then compared ( Table 3 ). The proportion of GPCs was significantly higher in the non-antibiotic group than in the antibiotic group (p <0.01).…”

Section: Resultsmentioning

confidence: 99%

Bacterial Flora in the Sphenoid Sinus Changes with Perioperative Prophylactic Antibiotic Administration

Baba

Hattori

Tahara

et al. 2021

Neurol. Med. Chir.(Tokyo)

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The complications of endonasal transsphenoidal surgery (ETSS) include meningitis and sinusitis, and these complications are troublesome. Some reports have investigated the type of bacteria and the susceptibility of sphenoid sinus mucosal flora to drugs. However, most specimens can be collected after perioperative antibiotic administration. In this study, 95 and 103 sphenoid sinus mucosal samples collected during ETSS from September 2013 to February 2015 and from June 2017 to January 2019, respectively, were examined for bacterial culture. Sphenoid sinus mucosal samples were collected after antibiotic administration in the first period, whereas samples were collected before antibiotic administration in the second period. Hence, the specimens in the second period were not affected by antibiotics. Moreover, drug susceptibility tests for the detected bacteria were performed. Overall, 52 and 51 bacterial isolates were collected during both periods. Gram-positive cocci (GPCs), including Staphylococcus aureus and Staphylococcus epidermidis , were more common in the non-antibiotic group than in the antibiotic group (p <0.01). However, the proportion of gram-negative rods (GNRs) did not significantly differ between the two groups (p = 0.54). The antibiotic group had a significantly higher proportion of bacteria resistant to ampicillin (p <0.01) and first-generation cephalosporin (p = 0.01) than the non-antibiotic group. In conclusion, there was a difference in bacterial flora in the sphenoid sinus mucosal samples collected before and after intraoperative antibiotic administration.

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“…It is important to repair CSF leakage with suitable material to avoid postoperative infection because the mortality rate from bacterial meningitis is as high as 12.0%. [ 10 ] In our hospital, we routinely suture the sellar dura with a PVDF suture and reconstruct the sellar floor with an autogenous bone graft. Fibrin glue is also used to cover the sutured dura and reconstructed floor.…”

Section: Discussionmentioning

confidence: 99%

Aspergillus sphenoiditis growth on long cut ends of a non-absorbable sellar floor dura closure suture

Eguchi¹,

Matsuoka²,

Suzuki³

et al. 2021

Surgical Neurology International

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Background: Cerebrospinal fluid (CSF) rhinorrhea is a common complication after transsphenoidal surgery (TSS). Suturing of sellar dura is effective in the prevention of postoperative CSF rhinorrhea, but it may cause rare postoperative infections. Herein, we report a case of Aspergillus sphenoiditis with the growth noted on cut ends of a polyvinylidene fluoride (PVDF) suture used for dural closure. Case Description: A previously healthy 51-year-old woman complained of abnormal odor 5 years after TSS for null cell adenoma. A white mass in the sphenoidal sinus was detected on rhinoscopy. Fungal balls were found clustered around the ends of a PVDF suture used for dural closure at the initial surgery. She underwent removal of both the fungal ball and dural suture. The pathological diagnosis was Aspergillus hyphae. It is thought that a dural suture protruding out of the sphenoid sinus mucosa can cause Aspergillus infection even in immunocompetent patients. A rapid and accurate diagnosis followed by surgical removal of the fungal ball and follow-up with oral antimycotic drugs result in good clinical outcomes. Conclusion: It is crucial to cut short the suture end and cover it with sphenoid sinus mucosa to avoid such complications.

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Risk Factors and Microbiology of Meningitis and/or Bacteremia After Transsphenoidal Surgery for Pituitary Adenoma

Cited by 22 publications

References 42 publications

Perioperative Antibiotic Use in Endoscopic Endonasal Skull Base Surgery

Perioperative Antibiotic Use in Endoscopic Endonasal Skull Base Surgery

Bacterial Flora in the Sphenoid Sinus Changes with Perioperative Prophylactic Antibiotic Administration

Aspergillus sphenoiditis growth on long cut ends of a non-absorbable sellar floor dura closure suture

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