title: The Efficacy of Antibacterial Prophylaxis Against the Development of Meningitis After Craniotomy: A Meta-Analysis.
abstract: OBJECTIVE
  Prophylactic antibiotics are widely used before craniotomy to prevent postoperative infections. A systematic review and meta-analysis was conducted to examine the effect of prophylactic antibiotics on meningitis after craniotomy.
  
  
  METHODS
  PubMed, EMBASE, and Cochrane databases were searched through October 2014 for randomized controlled trials that evaluated the effect of prophylactic antibiotics on meningitis after craniotomy. Pooled effect estimates were calculated using fixed-effects and random-effects models.
  
  
  RESULTS
  Seven studies with 2365 patients were included in the final analysis. All studies were randomized controlled trials with different antibiotic regimens. Prophylactic antibiotic use reduced the rate of meningitis after neurosurgery, with a pooled Peto odds ratio of 0.34 (95% confidence interval 0.18-0.63). Cochran's Q test indicated no significant heterogeneity among studies (I(2) = 0; P value for heterogeneity = 0.44). Subgroup analysis based on Gram-negative coverage, blinding design, and study quality demonstrated no statistically significant difference among these groups (P> 0.05 for all). A meta-regression on surgery duration (P = 0.52) and on antibiotics duration (P = 0.59) did not show significant differences in the results among studies.
  
  
  CONCLUSIONS
  This meta-analysis shows that prophylactic antibiotic use significantly decreases meningitis infections after craniotomy.
authors.affiliation: Massachusetts College of Pharmacy and Health Sciences University, Boston, Massachusetts, USA.
authors.forename: Amal F
authors.initials: AF
authors.lastname: Alotaibi
authors.affiliation: Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: awael58@gmail.com.
authors.forename: M Maher
authors.initials: MM
authors.lastname: Hulou
authors.affiliation: Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Vestal
authors.affiliation: Massachusetts College of Pharmacy and Health Sciences University, Boston, Massachusetts, USA.
authors.forename: Faisal
authors.initials: F
authors.lastname: Alkholifi
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Morteza
authors.initials: M
authors.lastname: Asgarzadeh
authors.affiliation: Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cote
authors.affiliation: Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Wenya Linda
authors.initials: WL
authors.lastname: Bi
authors.affiliation: Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ian F
authors.initials: IF
authors.lastname: Dunn
authors.affiliation: Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Massachusetts College of Pharmacy and Health Sciences University, Boston, Massachusetts, USA; Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Rania A
authors.initials: RA
authors.lastname: Mekary
authors.affiliation: Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Massachusetts College of Pharmacy and Health Sciences University, Boston, Massachusetts, USA; Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Smith
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D003399:Craniotomy / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016920:Meningitis, Bacterial / Q000453:epidemiology* / Q000517:prevention & control*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic prophylaxis; Craniotomy; Infections; Meningitis; Meta-analysis; Neurosurgery