gms | German Medical Science

Objective: Spondylodiscitis and intracranial as well as spinal empyema present challenging cases in the neurosurgical context, and often require a long-term intravenous antibiotic treatment. In order to prevent independent patients from an extensive hospital stay, intravenous antibiotic treatment can be performed in an outpatient setting. Current literature supports its advantages, but lacks data regarding neurosurgical patients. We hereby aim to provide evidence of potential benefits of outpatient antibiotic treatment in neurosurgical patients.

Methods: We prospectively enrolled all patients eligible for outpatient antibiotic treatment in our neurosurgical department. We assessed inflammation markers, the clinical status using the SF-36 and EQ-5D questionnaires and the length of hospital stay and readmittance.

Results: Over a period of 10 months, we included a total of 12 patients. 5 patients suffered from spinal infections (2 patients with spondylodiscitis, 2 spinal empyema, 1 postoperative infection), 7 patients presented with intracranial infections (5 patients with subdural empyema, 1 patient with intracranial abscess, 1 patient with hypophysitis). In 11/12 patients, we identified specific bacteria causing the inflammation (63.6% Staphylococcus species). Median duration of antibiotic treatment was 8 weeks (4 weeks intravenous followed by 4 weeks oral treatment). Mean length of hospital stay was 16 days (range 5-42 days). 2 complications were detected: 1 patient with adverse reaction due to flucloxacillin (leucopenia) and 1 patient with a thrombosis, none of them affected the overall outcome. Patient were satisfied with the outpatient antibiotic treatment.

Conclusion: Outpatient antibiotic treatment provides a satisfying alternative for independent patients requiring long-term intravenous antibiotics. All neurosurgical patients were successfully treated and described a high contentedness with the outpatient treatment.