BMC Infectious Diseases (Nov 2024)

Extended sequential intravenous and oral antimicrobial therapy improves cure rate in postoperative intracranial neurosurgical infections: a Spanish multicenter retrospective study

  • Víctor Asensi,
  • Carlos Vázquez-Fernández,
  • Silvia Suárez-Díaz,
  • Elia Asensi-Díaz,
  • Nerea Carrasco-Antón,
  • Ana García-Reyne,
  • Irene Panero,
  • María Victoria Muñoz,
  • José Manuel Guerra,
  • Javier Arístegui,
  • María Antonia Sepúlveda,
  • Xavier García-Calvo,
  • Carlos Dueñas,
  • Mercé Biosca,
  • Valentina Chiminazzo,
  • Julio Collazos

DOI
https://doi.org/10.1186/s12879-024-10204-7
Journal volume & issue
Vol. 24, no. 1
pp. 1 – 11

Abstract

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Abstract Background Postoperative intracranial neurosurgical infections (PINI) complicate < 5% neurosurgeries. Scarce attention was dedicated to the extension and characteristics of its antimicrobial management considering their high morbidity, not negligible mortality, delayed hospital stay and increased healthcare costs. Methods We analyzed retrospectively (2014–2023) 162 PINI from eight Spanish third-level academic hospitals. Results Elective clean craniotomies after tumor or vascular causes were the leading procedures. Epidural abscess (24.7%), scalp infections (19.8%), postsurgical meningitis (16.7%) and cranioplasty infections (16.7%) were the most frequent PINI. Gram negative bacteria (38.6%) and Staphylococcus spp (28.6%) were the predominant isolates. Overall 85.2% patients underwent pus drainage, mostly by craniotomy (40.3%). Interestingly 34% were already receiving antibiotics for extracranial infections before developing PINI while 16.8% did not receive pre-operative antibiotic prophylaxis. In total 77.2% patients started a combined intravenous (IV) antimicrobial therapy, of which 85.2% switched after 5 days to a second-line IV antibiotic regimen, in 41.3% cases combined, after pus culture results, for a median of 21 days. Overall 61.1% patients continued on oral antimicrobials after hospital discharge, 30.3% as a combined regimen, for a median of 42 days. Complete cure was obtained in 81.5% cases, while 11.1% relapsed, 7.4% failed to cure and 6.8% died after PINI complications. In the multivariate analysis oral antimicrobial therapy after hospital discharge (p = 0.001) was significantly associated with PINI cure with no effect on survival. Conclusions We conclude that an extended 6 weeks sequential IV and oral antimicrobial therapy in addition to neurosurgical correction increases PINI cure rate with no effect on survival. Clinical trial number Not applicable.

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