Antibiotic prophylaxis for subdural and subgaleal drains

Ariane Lewis Departments of Neurology and
Neurosurgery;

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Rajeev Sen NYU School of Medicine; and

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Travis C. Hill Neurosurgery;
NYU School of Medicine; and

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 PhD
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Herbert James NYU School of Medicine; and

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Jessica Lin Departments of Neurology and

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Harpaul Bhamra Departments of Neurology and

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Nina Martirosyan Pharmacy, NYU Langone Medical Center, New York, New York

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Donato Pacione Neurosurgery;

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OBJECTIVE

The authors sought to determine the effects of eliminating the use of prolonged prophylactic systemic antibiotics (PPSAs) in patients with subdural and subgaleal drains.

METHODS

Using a retrospective database, the authors collected data for patients over the age of 17 years who had undergone cranial surgery at their institution between December 2013 and July 2014 (PPSAs period) or between December 2014 and July 2015 (non-PPSAs period) and had subdural or subgaleal drains left in place postoperatively.

RESULTS

One hundred five patients in the PPSAs period and 80 in the non-PPSAs period were identified. The discontinuation of PPSAs did not result in an increase in the frequency of surgical site infection (SSI). The frequency of Clostridium difficile (CDI) and the growth of resistant bacteria were reduced in the non-PPSAs period in comparison with the PPSAs period. In the 8 months after the drain prophylaxis protocol was changed, $93,194.63 were saved in the costs of antibiotics and complications related to antibiotics.

CONCLUSIONS

After discontinuing PPSAs for patients with subdural or subgaleal drains at their institution, the authors did not observe an increase in the frequency of SSI. They did, however, note a decrease in the frequency of CDI and the growth of resistant organisms. It appears that not only can patients in this population do without PPSAs, but also that complications are avoided when antibiotic use is limited to 24 hours after surgery.

ABBREVIATIONS

CDC = Centers for Disease Control and Prevention; CDI = Clostridium difficile; PPSAs = prolonged prophylactic systemic antibiotics; SSI = surgical site infection.
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