Latreille Samuel, Bernard Rémy, Abi Lutfallah Antoine, Plaçais Marion, Jullien Victor, Belkheiri Bachir, Mathon Bertrand, Degos Vincent, Jacquens Alice, Korinek Anne-Marie
Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France.
Department of Neurosurgery, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France.
Neurosurgery. 2025 Sep 9. doi: 10.1227/neu.0000000000003719.
Postoperative central nervous system infections remain a major complication following craniotomy, with reported incidence ranging from 2.2% to 9.6%. The administration of preoperative antibiotic prophylaxis, particularly cephalosporins, has significantly reduced these infections. However, in patients reporting a penicillin allergy, alternatives such as vancomycin or clindamycin are recommended despite ongoing concerns about their efficacy. Recent studies have associated clindamycin use with a higher risk of surgical site infections (SSI) in various surgical specialties. This study aimed to assess clindamycin impact on SSI prevention in clean craniotomy.
A retrospective analysis was conducted using a prospective surveillance database focused on SSI and antibiotic prophylaxis monitoring. Patients who underwent clean craniotomy between 2005 and 2020 were included. After univariate and multivariate analyses, we performed causal inference analysis with a propensity score matching to assess the excess risk of SSI.
Among 12 347 patients, 93.8% received cefazolin and 6.2% clindamycin. The overall SSI rate was 2.45%. Clindamycin use significantly increased SSI risk in multivariate analysis (adjusted odds ratio adjusted: 2.52 [1.72-3.69]). The propensity score found increase of SSI rate (OR = 2.59 [1.71-3.94]) and of 90 days revision for infection (OR = 2.09 [1.23-3.54]). Other independent SSI risk factors included male sex, American Society of Anesthesiologists score ≥3, prolonged surgery, specific surgical diagnoses, and cerebrospinal fluid leakage, which was the strongest predictor (aOR = 38.51 [25.24-59.30]). The most frequently isolated pathogens were Cutibacterium acnes (28.5%) and methicillin-sensitive Staphylococcus aureus (24.5%). No significant differences were observed in bacterial distribution between antibiotic groups.
Clindamycin use is associated with an increased risk of SSI in clean craniotomy. Its bacteriostatic nature, and the proven safety of cefazolin in penicillin-allergic patients support maintaining cefazolin as the preferred antibiotic for every clean craniotomy patient. The safety of modifying prophylaxis protocols should be prospectively evaluated to optimize postoperative infection prevention.
开颅术后中枢神经系统感染仍然是一种主要并发症，报告的发生率在2.2%至9.6%之间。术前预防性使用抗生素，尤其是头孢菌素，已显著降低了这些感染的发生率。然而，对于报告有青霉素过敏的患者，尽管人们对万古霉素或克林霉素的疗效仍存在担忧，但仍推荐使用这些替代药物。最近的研究表明，在各个外科专科中，使用克林霉素会增加手术部位感染（SSI）的风险。本研究旨在评估克林霉素对清洁开颅手术中预防SSI的影响。
使用一个专注于SSI和抗生素预防监测的前瞻性监测数据库进行回顾性分析。纳入2005年至2020年间接受清洁开颅手术的患者。经过单因素和多因素分析后，我们进行了倾向评分匹配的因果推断分析，以评估SSI的额外风险。
在12347例患者中，93.8%接受了头孢唑林治疗，6.2%接受了克林霉素治疗。总体SSI发生率为2.45%。在多因素分析中，使用克林霉素显著增加了SSI风险（调整后的比值比：2.52 [1.72 - 3.69]）。倾向评分显示SSI发生率增加（OR = 2.59 [1.71 - 3.94]）以及因感染进行90天翻修的风险增加（OR = 2.09 [1.23 - 3.54]）。其他独立的SSI风险因素包括男性、美国麻醉医师协会评分≥3、手术时间延长、特定的手术诊断以及脑脊液漏，脑脊液漏是最强的预测因素（调整后的比值比 = 38.51 [25.24 - 59.30]）。最常分离出的病原体是痤疮丙酸杆菌（28.5%）和甲氧西林敏感金黄色葡萄球菌（24.5%）。在抗生素组之间，细菌分布未观察到显著差异。
在清洁开颅手术中，使用克林霉素会增加SSI的风险。其抑菌特性以及头孢唑林在青霉素过敏患者中已证实的安全性，支持将头孢唑林作为每例清洁开颅手术患者的首选抗生素。应前瞻性评估修改预防方案的安全性，以优化术后感染预防。
