Photo Credit: Mohammed Haneefa Nizamudeen

The following is a summary of “Extended sequential intravenous and oral antimicrobial therapy improves cure rate in postoperative intracranial neurosurgical infections: a Spanish multicenter retrospective study,” published in the November 2024 issue of Infectious Disease by Asensi et al. 

Researchers conducted a retrospective study to analyze the extension and characteristics of antimicrobial management in postoperative intracranial neurosurgical infections (PINI), considering the impact on morbidity, mortality, hospital stay, and healthcare costs.  

They analyzed 162 PINI from 2014 to 2023 across 8 Spanish third-level academic hospitals.  

The results showed that elective clean craniotomies for tumors or vascular causes were the most common procedures. The most frequent PINI were epidural abscesses (24.7%), scalp infections (19.8%), postsurgical meningitis (16.7%), and cranioplasty infections (16.7%). Gram-negative bacteria (38.6%) and Staphylococcus spp. (28.6%) were the most common isolates. A total of 85.2% of patients underwent pus drainage, primarily through craniotomy (40.3%). Notably, 34% of patients were receiving antibiotics for extracranial infections before developing PINI, and 16.8% did not receive pre-operative prophylactic antibiotics. A combined intravenous (IV) antimicrobial therapy was initiated in 77.2% of cases, with 85.2% switching to a second-line IV regimen after 5 days, often combined and guided by pus culture results, for a median of 21 days. After discharge, 61.1% of patients continued oral antimicrobials, 30.3% in combination, for a median of 42 days. A complete cure occurred in 81.5%, while 11.1% relapsed, 7.4% failed to cure, and 6.8% died from complications. Multivariate analysis found that oral antimicrobial therapy after discharge (P = 0.001) was significantly associated with cure, though it had no effect on survival.  

Investigators concluded an extended 6-week sequential IV and oral antimicrobial therapy, combined with neurosurgical correction, increased the PINI cure rate without affecting survival. 

Source: bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-10204-7