Korinek Anne-Marie, Baugnon Thomas, Golmard Jean-Louis, van Effenterre Rémy, Coriat Pierre, Puybasset Louis
Neuro-anesthesia Unit, Department of Anesthesiology, Pitié-Salpêtrière Hospital, University of Paris VI, Paris, France.
Neurosurgery. 2008 Feb;62 Suppl 2:532-9. doi: 10.1227/01.neu.0000316256.44349.b1.
To evaluate incidence and risk factors of postoperative meningitis, with special emphasis on antibiotic prophylaxis, in a series of 6243 consecutive craniotomies.
Meningitis was individualized from a prospective surveillance database of surgical site infections after craniotomy. Ventriculitis related to external ventricular drainage or cerebrospinal fluid shunt were excluded. From May 1997 until March 1999, no antibiotic prophylaxis was prescribed for scheduled, clean, lasting less than 4 hours craniotomies, whereas emergency, clean-contaminated, or long-lasting craniotomies received cloxacillin or amoxicillin-clavulanate. From April 1999 until December 2003, prophylaxis was given to every craniotomy. Independent risk factors for meningitis were studied by a multivariate analysis. Efficacy of antibiotic prophylaxis in preventing meningitis was studied as well as consequences on bacterial flora.
The overall meningitis rate was 1.52%. Independent risk factors were cerebrospinal fluid leakage, concomitant incision infection, male sex, and surgical duration. Antibiotic prophylaxis reduced incision infections from 8.8% down to 4.6% (P < 0.0001) but did not prevent meningitis: 1.63% in patients without antibiotic prophylaxis and 1.50% in those who received prophylaxis. Bacteria responsible for meningitis were mainly noncutaneous in patients receiving antibiotics and cutaneous in patients without prophylaxis. In the former, microorganisms tended to be less susceptible to the prophylactic antibiotics administered. Mortality rate was higher in meningitis caused by noncutaneous bacteria as compared with those caused by cutaneous microorganisms.
Perioperative antibiotic prophylaxis, although clearly effective for the prevention of incision infections, does not prevent meningitis and tends to select prophylaxis resistant microorganisms.
在连续6243例开颅手术中，评估术后脑膜炎的发生率及危险因素，尤其着重于抗生素预防。
脑膜炎是从开颅手术后手术部位感染的前瞻性监测数据库中区分出来的。排除与外部脑室引流或脑脊液分流相关的脑室炎。从1997年5月至1999年3月，对于计划内、清洁、持续时间少于4小时的开颅手术未给予抗生素预防，而急诊、清洁-污染或长时间的开颅手术则给予氯唑西林或阿莫西林-克拉维酸。从1999年4月至2003年12月，对每例开颅手术均给予预防。通过多变量分析研究脑膜炎的独立危险因素。研究抗生素预防在预防脑膜炎方面的效果以及对细菌菌群的影响。
总体脑膜炎发生率为1.52%。独立危险因素为脑脊液漏、伴发切口感染、男性及手术持续时间。抗生素预防使切口感染率从8.8%降至4.6%（P<0.0001）但未预防脑膜炎：未接受抗生素预防的患者中为1.63%，接受预防的患者中为1.50%。接受抗生素治疗的患者中引起脑膜炎的细菌主要为非皮肤细菌，未接受预防的患者中为皮肤细菌。在前者中，微生物往往对所给予的预防性抗生素敏感性较低。与皮肤微生物引起的脑膜炎相比，非皮肤细菌引起的脑膜炎死亡率更高。
围手术期抗生素预防虽然对预防切口感染明显有效，但不能预防脑膜炎，且倾向于选择对预防有抗性的微生物。
