title: Risk of Resistant Organisms and Clostridium difficile with Prolonged Systemic Antibiotic Prophylaxis for Central Nervous System Devices.
abstract: Prolonged systemic antibiotic prophylaxis for central nervous system (CNS) devices may be associated with increased risk of antimicrobial resistance. The primary objective of this study was to determine the impact of prolonged CNS device antibiotic prophylaxis on the growth of resistant microorganisms and Clostridium difficile.
  
  
  
  This retrospective, observational, cohort study included patients admitted to intensive care units with traumatic brain injury or other neurocritical illness. Patients who received a CNS device and antibiotic prophylaxis for at least 72 h were compared to patients with similar neurologic injuries who did not receive a CNS device.
  
  
  
  Study (n = 116) and control (n = 557) patients had mean APACHE II scores of 17.7 ± 9.2 and 15.1 ± 10.6 (p = 0.004) with 53.4 and 24.6 % receiving craniotomies (p < 0.001), respectively. Mean CNS device duration was 9.9 days, and 73 % of patients received cefuroxime for prophylaxis. The study cohort had a higher absolute incidence of resistant organisms compared with the control cohort (15.5 vs 4.1 %; odds ratio 1.93, 95 % CI 0.93-4.03, p = 0.078), though the study was underpowered to show statistical significance in multivariate analysis. C. difficile incidence was similar between groups (2.6 vs 2.0 %; odds ratio 1.45, 95 % CI 0.35-6.12, p = 0.61).
  
  
  
  We found a higher incidence of resistant organisms in patients receiving prolonged antibiotic prophylaxis with a CNS device, but similar incidence of C. difficile compared to controls. Lack of data supporting prolonged antibiotic prophylaxis for CNS devices and the risk of nosocomial infections with resistant organisms encourage limiting prophylactic antibiotics to a short periprocedural course.
authors.affiliation: Intermountain Medical Center, Murray, UT, USA. Stephanie.Chauv@imail.org.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Chauv
authors.affiliation: Intermountain Medical Center, Murray, UT, USA.
authors.forename: Gabriel V
authors.initials: GV
authors.lastname: Fontaine
authors.affiliation: Intermountain Medical Center, Murray, UT, USA.
authors.forename: Quang P
authors.initials: QP
authors.lastname: Hoang
authors.affiliation: Intermountain Medical Center, Murray, UT, USA.
authors.forename: Courtney B
authors.initials: CB
authors.lastname: McKinney
authors.affiliation: Intermountain Medical Center, Murray, UT, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Baldwin
authors.affiliation: Intermountain Medical Center, Murray, UT, USA.
authors.forename: Whitney R
authors.initials: WR
authors.lastname: Buckel
authors.affiliation: Intermountain Medical Center, Murray, UT, USA.
authors.forename: Dave S
authors.initials: DS
authors.lastname: Collingridge
authors.affiliation: Intermountain Medical Center, Murray, UT, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Majercik
authors.affiliation: Intermountain Medical Center, Murray, UT, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Wohlt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis / Q000009:adverse effects*; D001927:Brain Diseases / Q000175:diagnosis* / Q000628:therapy*; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002557:Cerebrospinal Fluid Shunts; D016360:Clostridioides difficile / Q000472:pathogenicity*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D064926:Neurophysiological Monitoring / Q000295:instrumentation*; D012189:Retrospective Studies; D012306:Risk
keywords: Antibiotic prophylaxis; Central nervous system devices; Clostridium difficile; Extraventricular drains; Infections; Intracranial pressure monitor; Resistant organisms; Ventriculitis