A Standardized Regimen of Antibiotics Prevents Infectious Complications in Skull Base Surgery

Abstract

Introduction: The current study was designed to evaluate a prospectively designed antibiotic regimen in patients undergoing craniofacial resection and compare it with a group of historic controls. Methods: A single-arm, prospective antibiotic regimen consisting of ceftazidime, flagyl (metronidazole), and vancomycin (CMV) was compared with a historic control of patients treated with nonstandard antibiotic therapy (nonCMV), all of whom underwent craniofacial resection. Outcome measures focused on incidence of infection, severity of infection, and operative mortality. Results: A total of 211 patients underwent craniofacial resection from 1973 to 2003. The standardized antibiotic therapy (CMV) was employed in 90 patients and the nonstandardized antibiotics (nonCMV) were used in 107 patients. Infectious wound complications were 11% within the CMV group versus 29% in the nonCMV regimen (p = 0.002). Moreover, the severity of infections was greatly diminished in the CMV group (p = 0.0001). Hospital stay and operative mortality were both adversely affected by the use of nonCMV antibiotic therapy. Conclusion: The data support the hypothesis that the use of a three-drug, broad-spectrum antibiotic regimen in skull base surgery reduces the incidence of infectious complications and appears to reduce operative mortality.