Article
The value of a perioperative antibiotic prophylaxis in transsphenoidal surgery and the risk of meningitis : a retrospective study on 100 procedures
Der Wert einer perioperativen Antibiotikaprophylaxe bei transsphenoidalen Operationen und das Risiko einer Meningitis: eine retrospektive Studie an 100 Eingriffen
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Published: | May 4, 2005 |
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Outline
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Objective
Although transsphenoidal surgery for sellar pathology has been classified as a “clean-contaminated” procedure with a higher potential risk of meningitis, the use of perioperative prophylactic antibiotics is controversial until today.
Methods
To evaluate the value of an antibiotic prophylaxis, we carried out a retrospective review of 100 transsphenoidal procedures (in which a single shot cefamandol prophylaxis was used) as well as of the pertinent literature. Possible risk factors for postoperative meningitis have been evaluated as well as the spectrum of germs causing this complication. The perioperative workup included cultures of preoperative nasal/oral and intraoperative sphenoidal mucosa swab specimens.
Results
In this study 4 procedures (4%) were complicated by meningitis despite antibiotic prophylaxis. We isolated Staphylococcus aureus and Streptococcus pneumoniae, but as in the literature, there is apparently a large variety of responsible microorganisms. During all of these 4 operations an intraoperative CSF leakage was observed. A postoperative CSF rhinorrhea was also identified as a significant risk factor (p<0,05). The predictive value of perioperative swab specimens was low.
Conclusions
Based on our results and the literature, there are no mandatory reasons for a perioperative antibiotic prophylaxis in transsphenoidal surgery, except in procedures with a CSF leakage. However, a prospective randomized control trial seems justified and necessary.