Premium
Antibiotic prophylaxis in anterior skull‐base surgery: a survey of the North American Skull Base Society
Author(s) -
Fang Christina H.,
Hawn Vivian S.,
Agarwal Vijay,
Moskowitz Howard S.,
Kshettry Varun R.,
McKean Erin L.,
Bellile Emily,
Akbar Nadeem A.,
Abuzeid Waleed M.
Publication year - 2019
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.22396
Subject(s) - medicine , antibiotics , odds ratio , surgery , diabetes mellitus , microbiology and biotechnology , biology , endocrinology
Background There is a paucity of data evaluating antibiotic use in anterior skull‐base surgery (ASBS). The goal of this study was to determine antibiotic prescribing patterns and factors that influence antibiotic use in ASBS. Methods An online‐based survey was distributed to the membership of the North American Skull Base Society in 2018. Outcomes included practitioner preference regarding intraoperative and postoperative antibiotic use, practice location and environment, surgeon experience, and patient factors influencing antibiotic use. Results There were 208 respondents (25.6% response rate) of which 182 (87.5%) performed ASBS; 60.4% were in academic institutions. Respondents were neurosurgeons (59.3%) or otolaryngologists (40.7%), and 75.3% were fellowship‐trained in ASBS. Most surgeons (95.0%) gave intraoperative antibiotics. Academic surgeons were 4 times more likely to prescribe intraoperative antibiotics than private practitioners (odds ratio [OR] 3.98; 95% confidence interval [CI], 1.53 to 10.36; p = 0.005). Among surgeons who did not routinely prescribe intraoperative antibiotics, regression analysis indicated that the presence of actively infected sinuses, transplantation, diabetes, human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), and pulmonary disease influenced decision‐making ( p < 0.03). Postoperative antibiotics were prescribed by 73.6% of respondents. European surgeons were 3 times less likely to prescribe postoperative antibiotics (OR 0.34; 95% CI, 0.15 to 0.80; p = 0.01). Regression modeling indicated that HIV/AIDS, cystic fibrosis, diabetes, transplantation, and pulmonary disease, as well as the use of absorbable packing influenced the decision to use postoperative antibiotics ( p < 0.003). Conclusion This study demonstrates the significant variation in intra‐ and postoperative antibiotic use among surgeons performing ASBS. Prospective randomized studies are necessary to establish evidence‐based practice guidelines for perioperative antibiotic use in ASBS.