title: Efficacy of ultra-short single agent regimen antibiotic chemo-prophylaxis in reducing the risk of meningitis in patients undergoing endoscopic endonasal transsphenoidal surgery.
abstract: OBJECTIVE
  The study aims to evaluate the incidence of infectious complications (namely meningitis) within 30 days after endoscopic endonasal transspheinodal neurosurgery (EETS) in patients receiving an ultra-short peri-operative chemo-prophylaxis regimen with 2 doses of 1st generation cephalosporin or macrolide.
  
  
  METHODS
  We retrospectively analyzed the clinical records of 145 patients who received an ultra-short chemoprophylaxis with two doses of an antibiotic, given 30 min before and 8h after EETS, over a 30-month time-frame. Ninety-seven patients (66.89%) received endovenous cefazolin, a 1st generation cephalosporin, administered at a dosage of 1000 mg, and 48 patients (33.10%) with an history of allergy to various agents, received endovenous clarithromycin at a dosage of 500 mg.
  
  
  RESULTS
  No case of peri- and post-operative meningitis occurred in patients receiving the 2 doses of antibiotic. Only one patient (0.68%) developed cerebral fluid leakage on the 7th postoperative day, which required the switching to a broad-spectrum antibiotic prophylaxis for one week; this patient received the ultrashort prophylaxis with a macrolide. In addition, 7 patients (4.82%) developed minor infectious complications such as low-grade fever (3 cases, all of them receiving cefazolin), enlarged submandibular and cervical lymphnodes (3 cases, all of them receiving cefazolin), and upper and lower respiratory tract infection (1 case receiving clarithromycin). The cost of this prophylaxis regimen ranged from 7.76 Euro (cefazolin) to 39.54 Euro (clarithromycin).
  
  
  CONCLUSIONS
  This study suggested that an ultra-short single-antibiotic prophylaxis is a safe, cheap and effective regimen to prevent post-operative meningitis in patients undergoing EETS and who do not require lumbar drainage after surgery. In these patients also the rate of minor infective complications was acceptable when compared with the previous more expensive regimen based on 3rd generation cephalosporin plus aminoglycoside or alone, that could be suitable only for at-risk patients (e.g. smokers, cerebrospinal leak or Cushing's diseases).
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery - Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Somma
authors.affiliation: Department of Clinical Medicine and Surgery, Section of Infectious Diseases - Universitàdegli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy. Electronic address: albertomaraolo84@alice.it.
authors.forename: Alberto Enrico
authors.initials: AE
authors.lastname: Maraolo
authors.affiliation: Department of Neurosciences, Division of Neurosurgery - Università degli Studi di Messina, Messina, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: Esposito
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery - Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy.
authors.forename: Luigi Maria
authors.initials: LM
authors.lastname: Cavallo
authors.affiliation: Department of Clinical Medicine and Surgery, Section of Infectious Diseases - Universitàdegli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy.
authors.forename: Grazia
authors.initials: G
authors.lastname: Tosone
authors.affiliation: Department of Clinical Medicine and Surgery, Section of Infectious Diseases - Universitàdegli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Orlando
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery - Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Cappabianca
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008581:Meningitis / Q000517:prevention & control*; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D013100:Sphenoid Bone / Q000601:surgery; D013101:Sphenoid Sinus / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: 1st generation cephalosporin; Chemo-prophylaxis; Endoscopic endonasal transsphenoidal surgery; Macrolides; Meningitis infectious complications