Infection risk in endovascular neurointerventions: a comparative analysis of 549 cases with and without prophylactic antibiotic use
Infection risk in endovascular neurointerventions: a comparative analysis of 549 cases with and without prophylactic antibiotic use
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DOI：
10.3171/2018.10.jns182540
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发表时间：
2020-03-01
影响因子：
4.1
通讯作者：
Riina, Howard A.
中科院分区：
文献类型：
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作者：
Burkhardt, Jan-Karl;Tanweer, Omar;Riina, Howard A.
目的尚未对神经血管内手术预防性使用抗生素进行系统分析。在作者的机构有一个独特的设置来解决这个问题，一些主治医生使用预防性抗生素（头孢唑林或万古霉素）的所有神经介入，而其他人一般不做.METHODS作者进行了回顾性分析，在Tisch医院，纽约大学Langone医学中心的484例患者的最后549神经介入手术。收集临床和放射学数据进行分析，包括预防性抗生素使用、局部或全身感染、感染实验室检查值和治疗。总体而言，306个动脉瘤、117个动静脉畸形/动静脉瘘、86个肿瘤和40个血管狭窄/夹层采用弹簧圈栓塞术（n = 109）、Pipeline栓塞器械（n = 197）、栓塞术（n = 203）或支架植入术（n = 40）进行治疗。有或无抗生素预防的患者在性别（p = 0.48）、是否存在多种干预（p = 0.67）、治疗的疾病（p = 0.11）或放置的干预器械（p = 0.55）方面无显著差异。抗生素预防组患者的平均年龄（53.4岁）显著低于未进行预防的患者（57.1岁; p = 0.014）。在该队列中确定了2例轻度局部腹股沟感染（0.36%），无全身感染（0%），每组各1例（1/ 265 [0.38%] vs 1/284 [0.35%]）。两例患者均通过局部引流（n = 1）和口服抗生素治疗（n = 1）完全恢复。结论：在该队列中，与血管内神经介入术（有或无预防性抗生素使用）相关的感染风险非常低。这些数据表明，常规使用抗生素预防似乎是不必要的，为了防止抗生素耐药性和降低成本，抗生素预防应保留给被认为感染风险增加的选定患者。
OBJECTIVE A systematic analysis on the utility of prophylactic antibiotics for neuroendovascular procedures has not been performed. At the authors' institution there is a unique setup to address this question, with some attending physicians using prophylactic antibiotics (cefazolin or vancomycin) for all of their neurointerventions while others generally do not.METHODS The authors performed a retrospective review of the last 549 neurointerventional procedures in 484 patients at Tisch Hospital, NYU Langone Medical Center. Clinical and radiological data were collected for analysis, including presence of prophylactic antibiotic use, local or systemic infection, infection laboratory values, and treatment. Overall, 306 aneurysms, 117 arteriovenous malformations/arteriovenous fistulas, 86 tumors, and 40 vessel stenosis/dissections were treated with coiling (n = 109), Pipeline embolization device (n = 197), embolization (n = 203), or stenting (n = 40).RESULTS Antibiotic prophylaxis was used in 265 of 549 cases (48%). There was no significant difference between patients with or without antibiotic prophylaxis in sex (p = 0.48), presence of multiple interventions (p = 0.67), diseases treated (p = 0.11), or intervention device placed (p = 0.55). The mean age of patients in the antibiotic prophylaxis group (53.4 years) was significantly lower than that of the patients without prophylaxis (57.1 years; p = 0.014). Two mild local groin infections (0.36%) and no systemic infections (0%) were identified in this cohort, with one case in each group (1/ 265 [0.38%] vs 1/284 [0.35%]). Both patients recovered completely with local drainage (n = 1) and oral antibiotic treatment (n = 1).CONCLUSIONS The risk of infection associated with endovascular neurointerventions with or without prophylactic antibiotic use was very low in this cohort. The data suggest that the routine use of antibiotic prophylaxis seems unnecessary and that to prevent antibiotic resistance and reduce costs antibiotic prophylaxis should be reserved for selected patients deemed to be at increased infection risk.