Perioperative antibiotic use in vagus nerve stimulator implantation: a clinical series.
OBJECTIVE
Preoperative antibiosis contributes up to one third of total antibiotic use in major hospitals. Choice of antibiotic is not uniformly standardized, and polypharmacy regimens may be used without knowing the effect on rates of surgical site infection, nonsurgical infections, or antibiotic resistance. Careful examination of trends in surgical prophylaxis is warranted. In this study, we aimed to examine our institution's experience with vagus nerve stimulator (VNS) implantation, focusing on association between perioperative antibiotic practices and postoperative infectious outcomes.


METHODS
We conducted a single-center case-control study using a retrospective chart review of 50 consecutively operated patients undergoing VNS implantation over 24 months by two experienced surgeons at our institution from April 2014 to March 2016. In each surgery, the technical procedure, operating room, and surgical team were the same, while surgeon's preference in antibiotic prophylaxis differed. Group 1 received a single dose of intravenous (IV) cefazolin (n = 26), and Group 2 received IV cefazolin, paired with one or both of gentamicin/vancomycin, in addition to a 10-day outpatient oral course of clindamycin (n = 24). Patient demographics, perioperative details, and minimum 3-month follow-up for infection and healthcare utilization were recorded. Student t tests were computed for significance.


RESULTS
Group 1 patients on average were older than group 2 patients (10.2, 7.1 years, p = 0.01), and length of surgery was longer (115.5, 91.9 min, p = 0.007). There were no differences in number of surgeons gowned (p = 0.11), presence of tracheostomy (p = 0.43) or gastrostomy (p = 0.20) tube, nonsurgical infections (p = 0.32), and number of postoperative emergency department (ED) visits (p = 0.22) or readmissions (p = 0.23). Neither group had VNS infections in the follow-up period.


CONCLUSIONS
Single preoperative dosing of one antibiotic appropriately chosen to cover typical skin flora conferred equal benefit to perioperative prophylactic polypharmacy in this study. There were no differences in postoperative infection events or ED visits/readmissions. Restraint with preoperative antibiosis shows equipoise in postoperative infection and overall resource utilization.
Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA.
Jeffrey S
JS
Raskin
Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA.
Daniel
D
Hansen
Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA.
Arvind
A
Mohan
Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA.
I-Wen
IW
Pan
Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA.
Daniel J
DJ
Curry
Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA. sklam@texaschildrens.org.
Sandi
http://orcid.org/0000-0003-3294-6637
S
Lam
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D016022:Case-Control Studies; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019990:Perioperative Care / Q000379:methods*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D055536:Vagus Nerve Stimulation / Q000009:adverse effects / Q000379:methods*
D000900:Anti-Bacterial Agents
Antibiotic prophylaxis; Neurosurgery; Pediatric; Quality; Quality improvement