title: Third-generation cephalosporins as antibiotic prophylaxis in neurosurgery: what's the evidence?
abstract: To analyze the role of third-generation cephalosporins as prophylactic antibiotics in neurosurgery. We reviewed the literature for data from randomized controlled trials (RCTs) on third-generation cephalosporins compared to other antibiotic regimen in neurosurgery. End point of the RCTs was the occurrence of surgical site infections (SSIs)--data were pooled in a fixed-effects meta-analysis. Five randomized controlled trials enrolling a total of 2209 patients were identified. The pooled odds ratio for SSIs (overall) with third-generation cephalosporins prophylaxis in the five RCTs was 0.94 (95% CI, 0.59-1.52; P=0.81). No significant difference between third-generation cephalosporins and alternative regimen was identified. When analyzing organ SSIs (osteomyelitis, meningitis, and others intracranial infections) in data derived from four RCTs (1596 patients), third-generation cephalosporins failed to show superiority (pooled odds ratio 0.88; 95% CI 0.45-1.74; P=0.72). Third-generation cephalosporin antibiotic prophylaxis fails to show superiority over conventional regimens regarding both incisional and organ related SSIs in neurosurgery.
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, 100050 Beijing, China; Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. Electronic address: dr_wmliu@hotmail.com.
authors.forename: Weiming
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091 Zurich, Switzerland.
authors.forename: Marian Christoph
authors.initials: MC
authors.lastname: Neidert
authors.affiliation: Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
authors.forename: Rob J M
authors.initials: RJ
authors.lastname: Groen
authors.affiliation: Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091 Zurich, Switzerland.
authors.forename: Christoph Michael
authors.initials: CM
authors.lastname: Woernle
authors.affiliation: Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
authors.forename: Hajo
authors.initials: H
authors.lastname: Grundmann
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002511:Cephalosporins / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D006801:Humans; D019635:Neurosurgical Procedures; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins
keywords: Antibiotic prophylaxis; Meta-analysis; Neurosurgery; Surgical site infections; Third-generation cephalosporins