Preoperative antibiotic prophylaxis regimen in brain tumour surgery in Sweden: a quasi-experimental study

Background There has been varied clinical practice concerning antibiotic prophylaxis in patients undergoing craniotomy. In Sweden, both Cloxacillin and Cefuroxime have frequently been used. We aimed to study the clinical effectiveness of these two regimens. Methods A quasi-experimental design was us...

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Veröffentlicht in:Acta neurochirurgica 2020-11, Vol.162 (11), p.2849-2856
Hauptverfasser: Skyrman, Simon, Bartek, Jiri, Haghighi, Maryam, Fornebo, Ida, Skoglund, Tomas, Jakola, Asgeir Store, von Vogelsang, Ann-Christin, Förander, Petter
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container_issue 11
container_start_page 2849
container_title Acta neurochirurgica
container_volume 162
creator Skyrman, Simon
Bartek, Jiri
Haghighi, Maryam
Fornebo, Ida
Skoglund, Tomas
Jakola, Asgeir Store
von Vogelsang, Ann-Christin
Förander, Petter
description Background There has been varied clinical practice concerning antibiotic prophylaxis in patients undergoing craniotomy. In Sweden, both Cloxacillin and Cefuroxime have frequently been used. We aimed to study the clinical effectiveness of these two regimens. Methods A quasi-experimental design was used. The sample consisted of 580 adult (> 18 years) patients operated 2012–2015, of which 375 received Cloxacillin (pre-intervention group) and 205 received Cefuroxime (intervention group). Primary endpoint was the incidence of surgical site infection (SSI) 12 months after surgery, while secondary endpoints were the need for reoperation due to SSI, the amount antibiotics used and the number of visits in the outpatient clinic related to SSI. A control group from another institution was reviewed to rule out clinical trial effects. Results When analysed by intention to treat, the pre-intervention group had a significant higher incidence of SSI, 13.3% (50/375) vs 5.4% (11/205) in the intervention group ( p  
doi_str_mv 10.1007/s00701-020-04309-6
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In Sweden, both Cloxacillin and Cefuroxime have frequently been used. We aimed to study the clinical effectiveness of these two regimens. Methods A quasi-experimental design was used. The sample consisted of 580 adult (&gt; 18 years) patients operated 2012–2015, of which 375 received Cloxacillin (pre-intervention group) and 205 received Cefuroxime (intervention group). Primary endpoint was the incidence of surgical site infection (SSI) 12 months after surgery, while secondary endpoints were the need for reoperation due to SSI, the amount antibiotics used and the number of visits in the outpatient clinic related to SSI. A control group from another institution was reviewed to rule out clinical trial effects. Results When analysed by intention to treat, the pre-intervention group had a significant higher incidence of SSI, 13.3% (50/375) vs 5.4% (11/205) in the intervention group ( p  &lt; 0.01). A treatment per protocol analysis confirmed the result. The number of reoperations due to SSI were significantly reduced in the intervention group, 3.4% (7/205) vs 8.3% (31/375) ( p  = 0.02), as was the total antibiotic use ( p  = 0.03) and the number of visits in the outpatient clinic ( p  &lt; 0.01). In the control group, the reoperation rate as result of SSI was lower ( p  = 0.02) prior to the opposite change from Cefuroxime to Cloxacillin, 1.8% (27/1529) vs 3.1% (43/1378). Conclusion In Sweden, Cefuroxime as prophylaxis in brain tumour surgery by craniotomy seems to be superior to Cloxacillin.</description><identifier>ISSN: 0001-6268</identifier><identifier>ISSN: 0942-0940</identifier><identifier>EISSN: 0942-0940</identifier><identifier>DOI: 10.1007/s00701-020-04309-6</identifier><identifier>PMID: 32383013</identifier><language>eng</language><publisher>Vienna: Springer Vienna</publisher><subject>Adult ; Anti-Bacterial Agents - administration &amp; dosage ; Anti-Bacterial Agents - therapeutic use ; Antibiotic Prophylaxis - methods ; Antibiotics ; Brain cancer ; Brain Neoplasms - surgery ; Brain tumors ; Cefuroxime ; Cefuroxime - administration &amp; dosage ; Cefuroxime - therapeutic use ; Cloxacillin ; Disease prevention ; Female ; Humans ; Incidence ; Infection ; Infectious Medicine ; Infektionsmedicin ; Interventional Radiology ; Kirurgi ; Male ; Medicine ; Medicine &amp; Public Health ; Middle Aged ; Minimally Invasive Surgery ; Neurologi ; Neurology ; Neuroradiology ; Neurosurgery ; Neurosurgical Procedures - adverse effects ; Neurosurgical Procedures - methods ; Original - Infection ; Original Article - Infection ; Outpatient care facilities ; Patients ; Prophylaxis ; Quasi-experimental methods ; Surgery ; Surgical Orthopedics ; Surgical site infections ; Surgical Wound Infection - drug therapy ; Surgical Wound Infection - epidemiology ; Surgical Wound Infection - prevention &amp; control ; Sweden ; Treatment Outcome</subject><ispartof>Acta neurochirurgica, 2020-11, Vol.162 (11), p.2849-2856</ispartof><rights>The Author(s) 2020</rights><rights>The Author(s) 2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). 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In Sweden, both Cloxacillin and Cefuroxime have frequently been used. We aimed to study the clinical effectiveness of these two regimens. Methods A quasi-experimental design was used. The sample consisted of 580 adult (&gt; 18 years) patients operated 2012–2015, of which 375 received Cloxacillin (pre-intervention group) and 205 received Cefuroxime (intervention group). Primary endpoint was the incidence of surgical site infection (SSI) 12 months after surgery, while secondary endpoints were the need for reoperation due to SSI, the amount antibiotics used and the number of visits in the outpatient clinic related to SSI. A control group from another institution was reviewed to rule out clinical trial effects. Results When analysed by intention to treat, the pre-intervention group had a significant higher incidence of SSI, 13.3% (50/375) vs 5.4% (11/205) in the intervention group ( p  &lt; 0.01). A treatment per protocol analysis confirmed the result. The number of reoperations due to SSI were significantly reduced in the intervention group, 3.4% (7/205) vs 8.3% (31/375) ( p  = 0.02), as was the total antibiotic use ( p  = 0.03) and the number of visits in the outpatient clinic ( p  &lt; 0.01). In the control group, the reoperation rate as result of SSI was lower ( p  = 0.02) prior to the opposite change from Cefuroxime to Cloxacillin, 1.8% (27/1529) vs 3.1% (43/1378). 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In Sweden, both Cloxacillin and Cefuroxime have frequently been used. We aimed to study the clinical effectiveness of these two regimens. Methods A quasi-experimental design was used. The sample consisted of 580 adult (&gt; 18 years) patients operated 2012–2015, of which 375 received Cloxacillin (pre-intervention group) and 205 received Cefuroxime (intervention group). Primary endpoint was the incidence of surgical site infection (SSI) 12 months after surgery, while secondary endpoints were the need for reoperation due to SSI, the amount antibiotics used and the number of visits in the outpatient clinic related to SSI. A control group from another institution was reviewed to rule out clinical trial effects. Results When analysed by intention to treat, the pre-intervention group had a significant higher incidence of SSI, 13.3% (50/375) vs 5.4% (11/205) in the intervention group ( p  &lt; 0.01). A treatment per protocol analysis confirmed the result. The number of reoperations due to SSI were significantly reduced in the intervention group, 3.4% (7/205) vs 8.3% (31/375) ( p  = 0.02), as was the total antibiotic use ( p  = 0.03) and the number of visits in the outpatient clinic ( p  &lt; 0.01). In the control group, the reoperation rate as result of SSI was lower ( p  = 0.02) prior to the opposite change from Cefuroxime to Cloxacillin, 1.8% (27/1529) vs 3.1% (43/1378). Conclusion In Sweden, Cefuroxime as prophylaxis in brain tumour surgery by craniotomy seems to be superior to Cloxacillin.</abstract><cop>Vienna</cop><pub>Springer Vienna</pub><pmid>32383013</pmid><doi>10.1007/s00701-020-04309-6</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record>
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subjects Adult
Anti-Bacterial Agents - administration & dosage
Anti-Bacterial Agents - therapeutic use
Antibiotic Prophylaxis - methods
Antibiotics
Brain cancer
Brain Neoplasms - surgery
Brain tumors
Cefuroxime
Cefuroxime - administration & dosage
Cefuroxime - therapeutic use
Cloxacillin
Disease prevention
Female
Humans
Incidence
Infection
Infectious Medicine
Infektionsmedicin
Interventional Radiology
Kirurgi
Male
Medicine
Medicine & Public Health
Middle Aged
Minimally Invasive Surgery
Neurologi
Neurology
Neuroradiology
Neurosurgery
Neurosurgical Procedures - adverse effects
Neurosurgical Procedures - methods
Original - Infection
Original Article - Infection
Outpatient care facilities
Patients
Prophylaxis
Quasi-experimental methods
Surgery
Surgical Orthopedics
Surgical site infections
Surgical Wound Infection - drug therapy
Surgical Wound Infection - epidemiology
Surgical Wound Infection - prevention & control
Sweden
Treatment Outcome
title Preoperative antibiotic prophylaxis regimen in brain tumour surgery in Sweden: a quasi-experimental study
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