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Ultra-short antibiotic prophylaxis guided by preoperative microbiological nasal swabs in endoscopic endonasal skull base surgery

  • Original Article - Pituitaries
  • Published:
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Abstract

Purpose

Endoscopic endonasal skull base surgery (EESBS) is a clean-contaminated procedure. Guidelines regarding the antibiotic prophylaxis in EESBS have not been developed yet, and today, there are no universally accepted protocols. In this article, we investigated the efficacy of our new ultra-short antibiotic prophylaxis protocol for EESBS guided by the cultural results of preoperative microbiological nasal swabs.

Methods

We defined as “nasal swab-related antibiotic protocol” the administration of a first-generation cephalosporin (cefazolin 2 g) in patients whose nasal swabs revealed the presence of normal nasal flora or methicillin-sensitive Staphylococcus aureus (MSSA), and the administration of vancomycin 1 g intravenously in patients whose nasal swabs revealed the presence of methicillin-resistant Staphylococcus aureus (MRSA) or with reported cephalosporin/penicillin allergy. This case-control study included 120 patients who underwent EESBS. The case group included 60 cases who received the “nasal swab-related antibiotic protocol,” while the control group included 60 cases who received the “standard hospital antibiotic protocol” used in neurosurgery (cefazolin 2 g plus metronidazole 500 mg at induction, and 2 g of cefazolin repeated after 180 min).

Results

The preoperative microbiological nasal swabs showed normal nasal flora in 42 patients (70%), MSSA in 17 patients (28.3%), and MRSA in 1 patient (1.6%). During the study period, no cases of meningitis or sinusitis occurred in the case group (“nasal swab-related antibiotic protocol”), while two infections (3.3%, 1 sinusitis and 1 meningitis) were reported in the control group (“standard hospital antibiotic protocol”). Mean length of hospitalization was 6.5 days for the case group and 8.5 days in the control group. “Standard hospital antibiotic protocol” is less expensive (range, 2.88–5.42 euros) compared with our new “nasal swab-related antibiotic protocol” (range, 10.02–32.56 euros), but in line with other antibiotic prophylaxis protocols reported in literature.

Discussion

The low complication rates of our case series (0%) is comparable to complication rates reported in literature (1.6% for meningitis and 8% for sinusitis). Compared with other perioperative antibiotic regimens reported in literature, the “nasal swab-related antibiotic protocol” is cheap and at least equally effective. We discuss the rationale on which we based the choice of chemoprophylaxis, the timing, and the length of our regimen.

Conclusions

Our study confirmed the safety and efficacy of our easily applicable and low-cost antibiotic prophylaxis protocol.

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Abbreviations

CSF:

Cerebrospinal fluid

EESBS:

Endoscopic endonasal skull base surgery

FSS:

Functional sinus surgery

NSF:

Nasoseptal flap

MDR:

Multidrug resistance

MRI:

Magnetic resonance imaging

MRSA:

Methicillin-resistant Staphylococcus aureus

MSSA:

Methicillin-sensitive Staphylococcus aureus

SSIs:

Surgical site infections

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Author information

Authors and Affiliations

  1. Division of Neurosurgery, San Martino- IST University Hospital (IRCCS), Genoa, Italy

    M. Ceraudo, A. Prior, A. Balestrino, P. Anania, P. Fiaschi, G. Zona & D. Criminelli Rossi

  2. Department of Infectious – Tropical Diseases and Microbiology, IST University Hospital (IRCCS), Genoa, Italy

    M. Camera

  3. Division of Neurosurgery, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, San Martino - IST University Hospital (IRCCS), Genoa, Italy

    P. Fiaschi & G. Zona

  4. Endocrinology Unit, San Martino - IST University Hospital (IRCCS), Genoa, Italy

    F. Gatto

  5. Department of Infectious – Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy

    N. Riccardi

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  1. M. Ceraudo
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  2. A. Prior
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  10. D. Criminelli Rossi
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Correspondence to M. Ceraudo.

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Ceraudo, M., Prior, A., Balestrino, A. et al. Ultra-short antibiotic prophylaxis guided by preoperative microbiological nasal swabs in endoscopic endonasal skull base surgery. Acta Neurochir 163, 369–382 (2021). https://doi.org/10.1007/s00701-020-04560-x

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