In a single-center experience, there was no difference in infection rate with versus without prophylaxis.
Use of prophylactic antibiotics does not appear to reduce infection among patients undergoing neurointerventional procedures, according to a study published online earlier this month in the Journal of Neurosurgery. In the single-center study, the overall infection rate was extremely low regardless of whether prophylactic antibiotics were employed.
Senior author Howard A. Riina, MD (New York University School of Medicine, NYU Langone Medical Center, New York, NY), told Neurovascular Exchange that use of antibiotic prophylaxis among those performing neurointerventional procedures at his center was not consistent. “I was always taught that the risk of infection from interventional procedures was low, so over the years I had gotten away from using antibiotics. We decided to do a study, because our volume was high, to look at the embolization cases over a period of time.”
Riina, along with lead author Jan-Karl Burkhardt, MD (New York University School of Medicine, NYU Langone Medical Center), and colleagues, retrospectively reviewed the last 549 neurointerventional procedures conducted on 484 patients at Tisch Hospital, NYU Langone Medical Center. Cases consisted of aneurysms (n = 306), arteriovenous malformations/arteriovenous fistulas (n = 117), tumors (n = 86), and vessel stenosis/dissections (n = 40). They were treated with coiling (n = 109), Pipeline embolization (n = 197), embolization (n = 203), or stenting (n = 40).
“It was a wide variety of embolizations [that we evaluated],” said Riina. “But we did not do it for angio. It was just for when we did a procedure where we were leaving something behind: devices, glues, stents, coils, and things like that.”
The investigators evaluated clinical and radiological data, including prophylactic antibiotic use, the presence of local or systemic infection, infection laboratory values, and treatment.
Antibiotic prophylaxis was used in 48% of cases. There were no differences between patients who did and did not receive antibiotic prophylaxis with respect to sex (P = 0.48), presence of multiple interventions (P = 0.67), diseases treated (P = 0.11), or type of device placed (P = 0.55). The mean age of patients in the antibiotic prophylaxis group was 53.4 years, which was significantly younger than the mean age of patients without prophylaxis (57.1 years; P = 0.014).
In the entire cohort, one mild local groin infection occurred in each group, for a rate of 0.38% in the prophylaxis patients and 0.35% in the nonprophylaxis patients. In both instances, the patients recovered completely after treatment, which consisted of local drainage in one case and oral antibiotic treatment in the other. There were no systemic infections.
An Opportunity to Tackle Antibiotic Overuse
“We found there really was no difference in infection rate,” said Riina. “As surgery moves more and more in the direction of less invasive, maybe there is an opportunity to reduce the use of antibiotics,” he explained. “If the infection rate is really that low for a lot of these procedures, maybe we can make some inroads there and improve the whole infection risk/benefit ratio.”
Riina and colleagues conclude that routine use of antibiotic prophylaxis should be reserved for selected high-risk patients to prevent antibiotic resistance and reduce cost.
“The big issue is the generation of super bugs at hospitals,” Riina said. “So, if you can reduce the amount of antibiotic use in general, I think that’s a good thing.” These findings, he said, can be used as evidence for those who might want to try foregoing antibiotic prophylaxis for neurointerventional cases.
Riina pointed out, however, that infection rates for different medical procedures vary considerably from institution to institution. As a result, there might be “an institutional mandate to look at when you can minimize the use of antibiotics.”
Burkhardt J-K, Tanweer O, Litao M, et al. . J Neurosurg. 2019;Epub ahead of print.
Riina reports no relevant conflicts of interest.