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Risk of Resistant Organisms and Clostridium difficile with Prolonged Systemic Antibiotic Prophylaxis for Central Nervous System Devices

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Abstract

Background

Prolonged systemic antibiotic prophylaxis for central nervous system (CNS) devices may be associated with increased risk of antimicrobial resistance. The primary objective of this study was to determine the impact of prolonged CNS device antibiotic prophylaxis on the growth of resistant microorganisms and Clostridium difficile.

Methods

This retrospective, observational, cohort study included patients admitted to intensive care units with traumatic brain injury or other neurocritical illness. Patients who received a CNS device and antibiotic prophylaxis for at least 72 h were compared to patients with similar neurologic injuries who did not receive a CNS device.

Results

Study (n = 116) and control (n = 557) patients had mean APACHE II scores of 17.7 ± 9.2 and 15.1 ± 10.6 (p = 0.004) with 53.4 and 24.6 % receiving craniotomies (p < 0.001), respectively. Mean CNS device duration was 9.9 days, and 73 % of patients received cefuroxime for prophylaxis. The study cohort had a higher absolute incidence of resistant organisms compared with the control cohort (15.5 vs 4.1 %; odds ratio 1.93, 95 % CI 0.93–4.03, p = 0.078), though the study was underpowered to show statistical significance in multivariate analysis. C. difficile incidence was similar between groups (2.6 vs 2.0 %; odds ratio 1.45, 95 % CI 0.35–6.12, p = 0.61).

Conclusion

We found a higher incidence of resistant organisms in patients receiving prolonged antibiotic prophylaxis with a CNS device, but similar incidence of C. difficile compared to controls. Lack of data supporting prolonged antibiotic prophylaxis for CNS devices and the risk of nosocomial infections with resistant organisms encourage limiting prophylactic antibiotics to a short periprocedural course.

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Acknowledgments

The authors would like to thank Ramon Castillo III for his role in data extraction.

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Authors and Affiliations

  1. Intermountain Medical Center, Murray, UT, USA

    Stephanie Chauv, Gabriel V. Fontaine, Quang P. Hoang, Courtney B. McKinney, Margaret Baldwin, Whitney R. Buckel, Dave S. Collingridge, Sarah Majercik & Paul D. Wohlt

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  1. Stephanie Chauv
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  2. Gabriel V. Fontaine
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  3. Quang P. Hoang
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  4. Courtney B. McKinney
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  5. Margaret Baldwin
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Correspondence to Stephanie Chauv.

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Chauv, S., Fontaine, G.V., Hoang, Q.P. et al. Risk of Resistant Organisms and Clostridium difficile with Prolonged Systemic Antibiotic Prophylaxis for Central Nervous System Devices. Neurocrit Care 25, 128–132 (2016). https://doi.org/10.1007/s12028-016-0254-x

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  • DOI: https://doi.org/10.1007/s12028-016-0254-x

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