title: Infection risk in neurointervention and cerebral angiography.
abstract: BACKGROUND
  The risk of infection with cerebral angiography and neurointerventional procedures has not been defined. Likewise, although the use of routine prophylactic antibiotics has been advocated by some neurointerventionalists, the utility of prophylactic antibiotics in this setting has not been determined.
  
  
  OBJECTIVE
  To determine the rate of infection associated with neuroangiographic procedures in a clinical setting in which prophylactic antibiotics are not routinely given.
  
  
  METHODS
  All cerebral angiograms and neurointerventional procedures done by a single neurointerventionalist over a recent 7-year period were retrospectively reviewed. Patients with infections directly attributable to the procedure were identified. A sample size calculation was done to determine the necessary size of a randomized, controlled trial aimed at determining whether prophylactic antibiotics can lower the rate of infection.
  
  
  RESULTS
  Among a total of 2918 cerebral angiograms and neurointerventional procedures done without prophylactic antibiotics, there were 3 infections (0.1%) attributable to the procedure. All infections were localized femoral artery infections with no systemic complications. One infection occurred in a patient who was immunosuppressed because of treatment for cancer. Two of the patients required surgical debridement; all were treated with intravenous antibiotics with resolution of all infections. There were no central nervous system infections and no deaths associated with the infections.
  
  
  CONCLUSIONS
  These data suggest that the overall risk of infection associated with most neuroangiographic procedures is very low. Prophylactic antibiotic use may be a reasonable option for selected patients but is probably unnecessary for standard use in the context of meticulous care during procedures.
authors.affiliation: Department of Surgery, Division of Neurosurgery, University of Alabama, Birmingham, Alabama 35294-3410, USA.
authors.forename: Prashant S
authors.initials: PS
authors.lastname: Kelkar
authors.forename: J Brett
authors.initials: JB
authors.lastname: Fleming
authors.forename: Beverly C
authors.initials: BC
authors.lastname: Walters
authors.forename: Mark R
authors.initials: MR
authors.lastname: Harrigan
mesh_terms: D000328:Adult; D019072:Antibiotic Prophylaxis; D018288:Carcinoma, Small Cell / Q000150:complications; D002533:Cerebral Angiography / Q000009:adverse effects*; D003646:Debridement; D004621:Embolization, Therapeutic; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007239:Infections / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D012306:Risk; D018401:Sample Size; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000601:surgery; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000382:microbiology
chemical_list: D007166:Immunosuppressive Agents