Efficacy of Short-Term versus Long-Term Post-Operative Antimicrobial Prophylaxis for Preventing Surgical Site Infection after Clean Neurosurgical Operations

Ji-soo Ha; Sae-moon Oh; Jeong-han Kang; Byung-moon Cho; Se-hyuck Park

doi:10.13004/kjnt.2012.8.0.104

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Efficacy of Short-Term versus Long-Term Post-Operative Antimicrobial Prophylaxis for Preventing Surgical Site Infection after Clean Neurosurgical Operations

Original Article

Korean J Nutr 2012;8(2):104-109.

Published online: 19 January 2012

DOI: https://doi.org/10.13004/kjnt.2012.8.0.104

Efficacy of Short-Term versus Long-Term Post-Operative Antimicrobial Prophylaxis for Preventing Surgical Site Infection after Clean Neurosurgical Operations

Ji-soo Ha, MD, Sae-moon Oh, MD, Jeong-han Kang, MD, Byung-moon Cho, MD, Se-hyuck Park, MD

Department of Neurosurgery, Hallym University College of Medicine, Seoul, Korea

Address for correspondence: ^Sae-moon ^Oh, ^MD Department of Neurosurgery, Hallym University College of Medicine, 150 Seongan-ro, Gangdong-gu, Seoul 134-814, Korea Tel: +82-2-2224-2236, Fax: +82-2-473-7387 E-mail: osm@hallym.or.kr

Received 28 June 2012 Revised 8 August 2012 Accepted 9 August 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective:

Surgical site infection (SSI) is a problem constantly uppermost in the minds of all surgeons, although the actual rate of occurrence is only 1-5% in general surgery. In neurosurgical fields, there have been a few papers published about efficacy of post-operative antimicrobial prophylaxis (PAMP) to prevent SSI, compared to well known effectiveness of preoperative antibiotics. Thus, infection rates of short-term PAMP groups and those of long-term PAMP groups were investigated to evaluate the effectiveness of PAMP and the efficacy of short-term PAMP compared to long-term PAMP for prevention of SSI.

Methods:

Between April 2010 and April 2012, we retrospectively analyzed the data of 35 patients in the aneurysmal neck clipping groups (short-term PAMP group: PAMP for 3 days and fewer, long-term PAMP group: PAMP for 10 days and more) and 79 patients in the microdiscectomy groups (short-term PAMP group: 3 days and fewer, long-term PAMP group: PAMP for 6 days and more).

Results:

In aneurysmal neck clipping groups, SSI occurred 23.1% of short-term PAMP group and 9.1% of long-term PAMP group (p=0.3370). And in microdiscectomy groups, SSI occurred 6.7% of short-term PAMP group and 4.1% of long-term PAMP group (p=0.9840).

Conclusion:

There is no significant difference between the short-term PAMP group and the long-term PAMP group in terms of SSI, regardless of operation type. We therefore suggest that short-term PAMP usage could be an appropriate therapy for preventing SSI in clean neurosurgical operations.

Keywords: Antibiotic prophylaxis, Surgical wound infection, Neurosurgical procedure

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FIGURE 1.

Patient population profile. PAMP inappropriate duration: patient who prescribed post-operative antibiotics from 4 days to 9 days after surgery in aneurysmal neck clipping group and patient who prescribed post operative antibiotics from 4 days to 6 days after surgery in microdiscectomy group. PAMP: post operative antimicrobial prophylaxis.

FIGURE 2.

Operation time of group A.

FIGURE 3.

Operation time of group B.

TABLE 1.

Demographic data of aneurysmal neck clipping group

	Group A1 (n=13)	Group A2 (n=22)	p-value
Sex			0.2925
Men	06	06
Women	07	16
Age	049.17±11.040	054.67±9.9000	0.1507
Hypertension			0.7260
Present	05	07
Absent	08	15
Diabetes mellitus			0.5193
Present	00	02
Absent	13	20
Smoking history			0.4630
Yes	03	09
No	10	13
BMI	022.65±3.1000	023.11±2.2700	0.6126
Operation time	418.46±107.28	363.41±102.16	0.1399

Continuous variables are expressed as mean±standard deviation, A1: aneurysmal neck clipping with short-term PAMP group, A2: aneurysmal neck clipping with long-term PAMP group. BMI: body mass index, PAMP: post-operative antimicrobial prophylaxis

TABLE 2.

Demographic data of microdiscectomy group

	Group B1 (n=30)	Group B2 (n=49)	p-value
Sex			0.1739
Men	19	22
Women	11	27
Age	051.17±15.77	050.67±13.77	0.8842
Hypertension			0.2416
Present	07	19
Absent	23	30
Diabetes mellitus			0.9077
Present	05	10
Absent	25	39
Smoking history			0.5558
Yes	80	09
No	22	40
BMI	024.32±03.18	024.40±03.95	0.9284
Operation time	148.67±89.80	141.22±87.81	0.7180

Continuous variables are expressed as mean±standard deviation, B1: microdiscectomy with short-term PAMP group, B2: microdiscectomy with long-term PAMP group. BMI: body mass index, PAMP: post-operative antimicrobial prophylaxis

TABLE 3.

Distribution patterns of surgical site infected patients

	Group A1 (n=13)	Group A2 (n=22)	p-value
Infection
Present	03	02
Absent	10	20
Rate	23.1%	9.1%	0.3370
	Group B1 (n=30)	Group B2 (n=49)	p-value
Infection
Present	02	02
Absent	28	47
Rate	06.7%	4.1%	0.9840

A1: aneurysmal neck clipping with short-term PAMP group, A2: aneurysmal neck clipping with long-term PAMP group, B1: microdiscectomy with short-term PAMP group, B2: microdiscectomy with long-term PAMP group, PAMP: post-operative antimicrobial prophylaxis

TABLE 4.

Characteristics of SSI patient in aneurysmal neck clipping group

Case	Group	Sex	Age	Infection type	Operation time	DM	Smoking	BMI
1	A1	M	43	D	10 hr	N	N	29.41
2	A1	F	52	S	8 hr 25 min	N	Y	20.60
3	A1	F	25	S	5 hr	N	N	26.58
4	A2	F	67	D	7 hr 20 min	Y	Y	23.18
5	A2	F	61	S	5 hr	N	Y	28.11

A1: aneurysmal neck clipping with short-term PAMP group, A2: aneurysmal neck clipping with long-term PAMP group, M: male, F: female, DM: diabetes mellitus, BMI: body mass index, D: deep infection, S: superficial infection, Y: yes, N: no, PAMP: postoperative antimicrobial prophylaxis, SSI: surgical site infection

TABLE 5.

Characteristics of SSI patient in microdiscectomy group

Case	Group	Sex	Age	Infection type	Operation time	DM	Smoking	BMI
6	B1	M	62	S	5 hr 10 min	N	N	26.06
7	B1	F	58	D	3 hr 25 min	N	N	26.24
8	B2	F	61	D	2 hr 15 min	Y	Y	25.15
9	B2	F	67	S	1 hr 50 min	N	Y	35.03

B1: microdiscectomy with short-term PAMP group, B2: microdiscectomy with long-term PAMP group, M: male, F: female, DM: diabetes mellitus, BMI: body mass index, D: deep infection, S: superficial infection, Y: yes, N: no, PAMP: post-operative antimicrobial prophylaxis, SSI: surgical site infection

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