Department of Neurosurgery, NYU Langone Health, New York, New York, USA.
Department of Neurosurgery, University of Miami Health System, Miami, Florida, USA.
World Neurosurg. 2022 Nov;167:e858-e864. doi: 10.1016/j.wneu.2022.08.091. Epub 2022 Aug 28.
Endoscopic endonasal approach (EEA) procedures are inherently contaminated due to direct access through the nasopharyngeal mucosa. The reported rate of postoperative meningitis in EEA procedures is 0.7%-3%. A variety of methods exist to minimize the risk of meningitis with antibiotic prophylaxis, although their value is not completely understood. This study investigated whether there is a difference in rates of postoperative meningitis based on Staphylococcus aureus colonization and use of preoperative antibiotic prophylaxis.
All adult patients who underwent EEA resection at our institution from 2013 to 2021 were retrospectively reviewed. Patients with preoperative cerebrospinal fluid infections were excluded. Data including recent preoperative infections, preoperative colonization status, antibiotic administration, and postoperative outcomes were recorded for each patient.
Of 483 patients identified (mean age, 51 years; range, 18-90 years; 274 [56.7%] female), 80 (16.6%) had a positive preoperative methicillin-resistant Staphylococcus aureus (MRSA)/methicillin-sensitive Staphylococcus aureus (MSSA) screening swab. Twenty-one (26.3%) colonized patients were treated with preoperative decolonizing antibiotics. Within 30 days of surgery, 13 (2.7%) patients developed culture-positive meningitis. There was no significant difference in meningitis rates based on MRSA/MSSA colonization status. Among colonized patients, there was no significant difference in rates of MRSA/MSSA meningitis based on preoperative antibiotic decolonization.
Postoperative rates of meningitis after EEA surgery were not significantly changed based on MRSA/MSSA colonization status of the patient or preoperative decolonization. The utility of preoperative testing of MRSA/MSSA status and antibiotics for decolonization to prevent postoperative meningitis should be further investigated.
由于经鼻内镜手术（EEA）通过鼻咽黏膜直接进入，因此具有固有污染性。EEA 手术后脑膜炎的报告发生率为 0.7%-3%。有多种方法可通过抗生素预防来降低脑膜炎的风险，尽管其价值尚未完全理解。本研究旨在调查基于金黄色葡萄球菌定植和使用术前抗生素预防的情况下，手术后脑膜炎的发生率是否存在差异。
回顾性分析了 2013 年至 2021 年期间在我院接受 EEA 切除术的所有成年患者。排除术前有脑脊液感染的患者。记录每位患者的近期术前感染、术前定植状态、抗生素使用和术后结果等数据。
在确定的 483 例患者中（平均年龄 51 岁；范围，18-90 岁；274 例[56.7%]为女性），80 例（16.6%）患者术前耐甲氧西林金黄色葡萄球菌（MRSA）/甲氧西林敏感金黄色葡萄球菌（MSSA）筛查拭子阳性。21 例（26.3%）定植患者接受了术前去定植抗生素治疗。在手术后 30 天内，有 13 例（2.7%）患者发生了培养阳性的脑膜炎。MRSA/MSSA 定植状态与脑膜炎发生率之间无显著差异。在定植患者中，术前抗生素去定植与 MRSA/MSSA 脑膜炎的发生率之间也无显著差异。
根据患者的 MRSA/MSSA 定植状态或术前去定植情况，EEA 手术后脑膜炎的发生率没有显著变化。应进一步研究术前检测 MRSA/MSSA 状态和使用抗生素去定植以预防术后脑膜炎的效用。
