title: The Role of Antibiotic Prophylaxis in Clean Neurosurgery.
abstract: OBJECTIVE
  To investigate the efficacy of antibiotic prophylaxis (AP) and the risk factors for postoperative infections in clean neurosurgery.
  
  
  METHODS
  Data were retrospectively collected on all patients who had undergone clean neurosurgical operation at our institution between January 2009 and December 2014. From January 2009 until October 2011, AP was administered to every clean neurosurgical patient. From November 2011 to December 2014, no AP (n-AP) was prescribed for all clean neurosurgical operations. The efficacy of AP and independent risk factors for infection were studied.
  
  
  RESULTS
  A total of 808 clean neurosurgical cases were included. The AP group comprised 360 surgical cases, including 29 meningitis cases and 2 cases of incision infections, whereas the n-AP group consisted of 448 surgical cases, including 35 meningitis cases and 4 cases of incision infections (P = 0.848). Microorganisms were identified in 7 of 29 cases in the AP group compared with their identification in 22 of 35 cases in the n-AP group (P = 0.002). The percentage of patients with multidrug-resistant bacterial meningitis in the AP group was 57.1% compared with 13.6% in the n-AP group (P = 0.038). The risk factors for postoperative infection were cerebrospinal fluid leakage (odds ratio, 27.8; 95% confidence interval, 9.38-28.55) and surgery time (odds ratio, 1.12; 95% confidence interval, 1.02-1.22).
  
  
  CONCLUSIONS
  Our results show that in our data set, AP had no preventive effect on postoperative infections in clean neurosurgery. In addition, AP appeared to decrease the positive bacterial culture rate and to promote the emergence of multidrug-resistant bacteria. Cerebrospinal fluid leakage and surgery time were the risk factors for postoperative infection.
authors.affiliation: Graduate School of Tianjin Medical University, Tianjin, China; Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China.
authors.forename: YiYao
authors.initials: Y
authors.lastname: Cao
authors.affiliation: Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Disease, Tianjin Neurosurgical Institute, Tianjin, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Pu
authors.affiliation: Graduate School of Tianjin Medical University, Tianjin, China; Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China.
authors.forename: Guodong
authors.initials: G
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China.
authors.forename: XueJiang
authors.initials: X
authors.lastname: Yan
authors.affiliation: Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Xue
authors.affiliation: Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China.
authors.forename: ZhiMing
authors.initials: Z
authors.lastname: Sun
authors.affiliation: Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Disease, Tianjin Neurosurgical Institute, Tianjin, China. Electronic address: lqg369@126.com.
authors.forename: QingGuo
authors.initials: Q
authors.lastname: Li
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D065634:Cerebrospinal Fluid Leak / Q000175:diagnosis / Q000453:epidemiology*; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data*; D061646:Operative Time; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Neurosurgery; Postoperative infection; Prophylaxis; Surgical site infection