Infection risk in endovascular neurointerventions: a comparative analysis of 549 cases with and without prophylactic antibiotic use

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OBJECTIVE

A systematic analysis on the utility of prophylactic antibiotics for neuroendovascular procedures has not been performed. At the authors’ institution there is a unique setup to address this question, with some attending physicians using prophylactic antibiotics (cefazolin or vancomycin) for all of their neurointerventions while others generally do not.

METHODS

The authors performed a retrospective review of the last 549 neurointerventional procedures in 484 patients at Tisch Hospital, NYU Langone Medical Center. Clinical and radiological data were collected for analysis, including presence of prophylactic antibiotic use, local or systemic infection, infection laboratory values, and treatment. Overall, 306 aneurysms, 117 arteriovenous malformations/arteriovenous fistulas, 86 tumors, and 40 vessel stenosis/dissections were treated with coiling (n = 109), Pipeline embolization device (n = 197), embolization (n = 203), or stenting (n = 40).

RESULTS

Antibiotic prophylaxis was used in 265 of 549 cases (48%). There was no significant difference between patients with or without antibiotic prophylaxis in sex (p = 0.48), presence of multiple interventions (p = 0.67), diseases treated (p = 0.11), or intervention device placed (p = 0.55). The mean age of patients in the antibiotic prophylaxis group (53.4 years) was significantly lower than that of the patients without prophylaxis (57.1 years; p = 0.014). Two mild local groin infections (0.36%) and no systemic infections (0%) were identified in this cohort, with one case in each group (1/265 [0.38%] vs 1/284 [0.35%]). Both patients recovered completely with local drainage (n = 1) and oral antibiotic treatment (n = 1).

CONCLUSIONS

The risk of infection associated with endovascular neurointerventions with or without prophylactic antibiotic use was very low in this cohort. The data suggest that the routine use of antibiotic prophylaxis seems unnecessary and that to prevent antibiotic resistance and reduce costs antibiotic prophylaxis should be reserved for selected patients deemed to be at increased infection risk.

ABBREVIATIONS AVF = arteriovenous fistula; AVM = arteriovenous malformation; PED = Pipeline embolization device; PICA = posterior inferior cerebellar artery; VA = vertebral artery.

Article Information

Correspondence Howard A. Riina: NYU Langone Medical Center, New York, NY. howard.riina@nyumc.org.

INCLUDE WHEN CITING Published online February 8, 2019; DOI: 10.3171/2018.10.JNS182540.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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    Case example of a 12-year-old male patient with groin infection with antibiotic prophylaxis. Images show an unruptured left VA aneurysm with a size of 22 mm on sagittal T2-weighted MRI (A) and catheter angiography on anteroposterior (B) and lateral (C) projections before treatment and anteroposterior (D) and lateral (E) catheter angiography projections as well as sagittal T2-weighted MRI (F) after treatment with PED and coiling.

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    Case example of a 31-year-old male patient with groin infection without antibiotic prophylaxis. Images show a left VA dissection and small pseudoaneurysm formation on anteroposterior (A and C) and lateral (B and D) catheter angiography projections before (A and B) and after (C and D) treatment with PED.

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