The effect of duration of prophylactic antibiotics on postoperative intracranial infection in neurosurgeries with class I wound: An RCT study

Objective To evaluate the effect of varying duration of prophylactic antibiotics on the incidence of postoperative intracranial infection in neurosurgeries with Class Ⅰ wound. Methods A total of 1 130 patients were enrolled into this prospective study who underwent neurosurgeries with Class Ⅰ wound at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from August 2015 to March 2016. Based on the risk-stratified scales for postoperative intracranial infection, all patients were classified into two groups: low-risk group (LRG, n=807) and high-risk group (HRG, n=323). The two groups were further randomized into subgroups with various duration of postoperative prophylactic antibiotics. Specifically, LRG was subdivided into 0 h and 24 h subgroups (n=414 and 393, respectively). HRG was subdivided into 24 h, 48 h and 72 h subgroups (n=116, 113 and 94, respectively). The incidence of postoperative intracranial infections were compared between subgroups using Chi-square test. Results The incidences of intracranial infections were 2.9%(12/414) and 2.0%(8/393) in 0 h and 24 h subgroups within LRG, respectively; and they were 8.6%(10/116), 13.3%(15/113) and 11.7%(11/94) in 24 h, 48 h and 72 h subgroups within HRG, respectively. The incidence of intracranial infection was significantly higher in HRG than LRG among the patients who received prophylactic antibiotics for 24 h post operation (χ2=11.385, P=0.001). There was no significant difference in the incidence of postoperative intracranial infection between the subgroups within the same group (all P>0.05). Conclusions Patients undergoing neurosurgeries with Class Ⅰ wound could be divided into low-risk and high-risk groups. Extended or shortened postoperative prophylactic antibiotics may not be able to significantly affect the incidence of postoperative intracranial infection. Key words: Central nervous system bacterial infections; Neurosurgical procedures; Antibiotic prophylaxis