Effect of Staphylococcal Decolonization Regimen and Change in Antibiotic Prophylaxis Regimen on Incidence of Postcraniotomy Aseptic Meningitis.

Abstract

To study the effect of a staphylococcal decolonization regimen (SDR) and change in antibiotic prophylaxis regimen on postoperative meningitis (bacterial and aseptic) rates in patients undergoing elective cranial surgery. Data on elective craniotomy (supratentorial and infratentorial) were collected retrospectively for a total of 4 years-2 years before (2011-2012; group A) and 2 years after (2014-2015; group B) initiation of a SDR and a change in the antibiotic prophylaxis regimen (from chloramphenicol to ceftriaxone) in a neurosurgical unit of a tertiary care hospital. The SDR consisted of a 4% chlorhexidine scrub bath once a day and 10% betadine ointment application intranasally twice daily for ≥2 days before surgery. A total of 1349 patients (GROUP A, n = 622; group B, n = 727) were included in the present study, of whom 806 (59.7%) were males. Of the 1349 patients, 43 (3.2%) developed postoperative meningitis. Of these 43 patients, 8 (0.6%) had bacterial meningitis (BM) and 35 (2.6%) had aseptic meningitis (AM). A reduction occurred in the incidence of both BM and AM in group B; however, the reduction was statistically significant only for AM (P = 0.48 for BM; P = 0.019 for AM). Multivariate analysis showed that the initiation of an SDR conferred a significant protective effect against developing postoperative AM (relative risk, 0.31; 95% confidence interval, 0.14-0.70; P = 0.005). Our data showed that the incidence of AM can be reduced with an SDR and appropriate antibiotic prophylaxis. These findings lend support to the suspicion that AM might be a form of low-grade BM possibly due to a staphylococcal infection.