The Efficacy of Antibacterial Prophylaxis Against the Development of Meningitis After Craniotomy: A Meta-Analysis.

Authors:
Amal F Alotaibi
Amal F Alotaibi
MCPHS University
Boston | United States
Matthew Vestal
Matthew Vestal
Cushing Neurosurgical Outcomes Center
Boston | United States
Faisal Alkholifi
Faisal Alkholifi
Massachusetts College of Pharmacy and Health Sciences University
United States
Morteza Asgarzadeh
Morteza Asgarzadeh
Harvard School of Public Health
Boston | United States
David J Cote
David J Cote
Brigham and Women's Hospital
Boston | United States
Wenya Linda Bi
Wenya Linda Bi
Brigham and Women's Hospital
United States
Ian F Dunn
Ian F Dunn
Brigham and Women's Hospital
Boston | United States

World Neurosurg 2016 Jun 26;90:597-603.e1. Epub 2016 Feb 26.

Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Massachusetts College of Pharmacy and Health Sciences University, Boston, Massachusetts, USA; Harvard School of Public Health, Boston, Massachusetts, USA.

Objective: Prophylactic antibiotics are widely used before craniotomy to prevent postoperative infections. A systematic review and meta-analysis was conducted to examine the effect of prophylactic antibiotics on meningitis after craniotomy.

Methods: PubMed, EMBASE, and Cochrane databases were searched through October 2014 for randomized controlled trials that evaluated the effect of prophylactic antibiotics on meningitis after craniotomy. Pooled effect estimates were calculated using fixed-effects and random-effects models.

Results: Seven studies with 2365 patients were included in the final analysis. All studies were randomized controlled trials with different antibiotic regimens. Prophylactic antibiotic use reduced the rate of meningitis after neurosurgery, with a pooled Peto odds ratio of 0.34 (95% confidence interval 0.18-0.63). Cochran's Q test indicated no significant heterogeneity among studies (I(2) = 0; P value for heterogeneity = 0.44). Subgroup analysis based on Gram-negative coverage, blinding design, and study quality demonstrated no statistically significant difference among these groups (P> 0.05 for all). A meta-regression on surgery duration (P = 0.52) and on antibiotics duration (P = 0.59) did not show significant differences in the results among studies.

Conclusions: This meta-analysis shows that prophylactic antibiotic use significantly decreases meningitis infections after craniotomy.

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http://dx.doi.org/10.1016/j.wneu.2016.02.048DOI Listing

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June 2016
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