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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Figures

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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.

References

1

AL-Okaili RPatel SJ: Brain abscess after endovascular coiling of a saccular aneurysm: case report. AJNR Am J Neuroradiol 23:6976992002

2

Bullock Rvan Dellen JRKetelbey WReinach SG: A double-blind placebo-controlled trial of perioperative prophylactic antibiotics for elective neurosurgery. J Neurosurg 69:6876911988

3

Chen GZhan SChen WLi ZZhou DZeng S: Brain abscess after endosaccular embolisation of a cerebral aneurysm. J Clin Neurosci 21:1631652014

4

Dion JEGates PCFox AJBarnett HJBlom RJ: Clinical events following neuroangiography: a prospective study. Stroke 18:99710041987

5

Djindjian MLepresle EHoms JB: Antibiotic prophylaxis during prolonged clean neurosurgery. Results of a randomized double-blind study using oxacillin. J Neurosurg 73:3833861990

6

Earnest F IVForbes GSandok BAPiepgras DGFaust RJIlstrup DM: Complications of cerebral angiography: prospective assessment of risk. AJR Am J Roentgenol 142:2472531984

7

Kaufmann TJHuston J IIIMandrekar JNSchleck CDThielen KRKallmes DF: Complications of diagnostic cerebral angiography: evaluation of 19,826 consecutive patients. Radiology 243:8128192007

8

Kelkar PSFleming JBWalters BCHarrigan MR: Infection risk in neurointervention and cerebral angiography. Neurosurgery 72:3273312013

9

Kirollos RWBosma JJRadhakrishnan JPigott TD: Endovascularly treated cerebral aneurysm using Guglielmi detachable coils acting as a nidus for brain abscess formation secondary to Salmonella bacteremia: case report. Neurosurgery 51:2342382002

10

Lewis ALin JJames HKrok ACZeoli NHealy J: A single-center intervention to discontinue postoperative antibiotics after spinal fusion. Br J Neurosurg 32:1771812018

11

Petignat CFrancioli PHarbarth SRegli LPorchet FReverdin A: Cefuroxime prophylaxis is effective in noninstrumented spine surgery: a double-blind, placebo-controlled study. Spine (Phila Pa 1976) 33:191919242008

12

Savitz SIRivlin MMSavitz MH: The ethics of prophylactic antibiotics for neurosurgical procedures. J Med Ethics 28:3583632002

13

Sharma AJagetia ALoomba PSingh DTandon M: Delayed brain abscess after embolization of arterio-venous malformation: report of two cases and review of literature. Neurol India 59:6206232011

14

Venkatesan AMKundu SSacks DWallace MJWojak JCRose SC: Practice guidelines for adult antibiotic prophylaxis during vascular and interventional radiology procedures. J Vasc Interv Radiol 21:161116312010 (Erratum in J Vasc Interv Radiol 22:263 2011)

15

Willinsky RATaylor SMTerBrugge KFarb RITomlinson GMontanera W: Neurologic complications of cerebral angiography: prospective analysis of 2,899 procedures and review of the literature. Radiology 227:5225282003

16

Zurin AAUshikoshi SHoukin KKikuchi YAbe HSaitoh H: Cerebral abscess as an unusual complication of coil embolization in a dural arteriovenous fistula. Case report. J Neurosurg 87:1091121997

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