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oai:recercat.cat:11351/126532025-10-24T10:35:41Zcom_2072_378070com_2072_378040col_2072_378092

Extended sequential intravenous and oral antimicrobial therapy improves cure rate in postoperative intracranial neurosurgical infections: a Spanish multicenter retrospective study Asensi, Víctor Vázquez Fernández, Carlos Suárez-Díaz, Silvia Asensi-Díaz, Elia Carrasco-Antón, Nerea García-Reyne, Ana biosca, mercedes Institut Català de la Salut [Asensi V] Infectious Diseases-HIV Unit, Hospital Universitario Central de Asturias, Oviedo, Spain. Microbiology and Infectious Diseases Group, FINBA-ISPA, Oviedo, Spain. [Vázquez-Fernández C, Suárez-Díaz S] Infectious Diseases-HIV Unit, Hospital Universitario Central de Asturias, Oviedo, Spain. [Asensi-Díaz E, Carrasco-Antón N] Internal Medicine Service, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain. [García-Reyne A] Internal Medicine Service, Hospital 12 Octubre, Madrid, Spain. [Biosca M] Servei de Medicina Interna, Vall d’Hebron Hospital Universitari, Barcelona, Spain Vall d'Hebron Barcelona Hospital Campus Medicació oral Teràpia intravenosa Medicaments antiinfecciosos - Ús terapèutic Sistema nerviós - Cirurgia Infeccions quirúrgiques DISEASES::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Postoperative Complications::Surgical Wound Infection DISEASES::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Postoperative Complications ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Neurosurgical Procedures CHEMICALS AND DRUGS::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Anti-Bacterial Agents Other subheadings::Other subheadings::/therapeutic use ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Drug Therapy::Drug Administration Routes::Administration, Oral ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Drug Therapy::Drug Administration Routes::Administration, Intravenous ENFERMEDADES::afecciones patológicas, signos y síntomas::procesos patológicos::complicaciones posoperatorias::infección de la herida quirúrgica TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::procedimientos neuroquirúrgicos COMPUESTOS QUÍMICOS Y DROGAS::acciones y usos químicos::acciones farmacológicas::usos terapéuticos::antiinfecciosos::antibacterianos Otros calificadores::Otros calificadores::/uso terapéutico TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::farmacoterapia::vías de administración de medicamentos::administración oral TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::farmacoterapia::vías de administración de medicamentos::administración intravenosa ENFERMEDADES::afecciones patológicas, signos y síntomas::procesos patológicos::complicaciones posoperatorias Antimicrobial therapy; Intracranial infections; Neurosurgery Terapia antimicrobiana; Infecciones intracraneales; Neurocirugía Teràpia antimicrobiana; Infeccions intracranials; Neurocirurgia Background Postoperative intracranial neurosurgical infections (PINI) complicate < 5% neurosurgeries. Scarce attention was dedicated to the extension and characteristics of its antimicrobial management considering their high morbidity, not negligible mortality, delayed hospital stay and increased healthcare costs. Methods We analyzed retrospectively (2014–2023) 162 PINI from eight Spanish third-level academic hospitals. Results Elective clean craniotomies after tumor or vascular causes were the leading procedures. Epidural abscess (24.7%), scalp infections (19.8%), postsurgical meningitis (16.7%) and cranioplasty infections (16.7%) were the most frequent PINI. Gram negative bacteria (38.6%) and Staphylococcus spp (28.6%) were the predominant isolates. Overall 85.2% patients underwent pus drainage, mostly by craniotomy (40.3%). Interestingly 34% were already receiving antibiotics for extracranial infections before developing PINI while 16.8% did not receive pre-operative antibiotic prophylaxis. In total 77.2% patients started a combined intravenous (IV) antimicrobial therapy, of which 85.2% switched after 5 days to a second-line IV antibiotic regimen, in 41.3% cases combined, after pus culture results, for a median of 21 days. Overall 61.1% patients continued on oral antimicrobials after hospital discharge, 30.3% as a combined regimen, for a median of 42 days. Complete cure was obtained in 81.5% cases, while 11.1% relapsed, 7.4% failed to cure and 6.8% died after PINI complications. In the multivariate analysis oral antimicrobial therapy after hospital discharge (p = 0.001) was significantly associated with PINI cure with no effect on survival. Conclusions We conclude that an extended 6 weeks sequential IV and oral antimicrobial therapy in addition to neurosurgical correction increases PINI cure rate with no effect on survival. Clinical trial number Not applicable. The Infectious Diseases Working Group of the Spanish Society of Internal Medicine (SEMI) supported and funded this study. 2025-02-26T08:16:49Z 2025-02-26T08:16:49Z 2024-11-26 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Asensi V, Vázquez-Fernández C, Suárez-Díaz S, Asensi-Díaz E, Carrasco-Antón N, García-Reyne A, et al. Extended sequential intravenous and oral antimicrobial therapy improves cure rate in postoperative intracranial neurosurgical infections: a Spanish multicenter retrospective study. BMC Infect Dis. 2024 Nov 26;24:1345. 1471-2334 https://hdl.handle.net/11351/12653 10.1186/s12879-024-10204-7 39587499 001376872500001 http://hdl.handle.net/11351/12653 eng BMC Infectious Diseases;24 https://doi.org/10.1186/s12879-024-10204-7 Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess application/pdf BMC Scientia