Introduction: Surgical antibiotic prophylaxis contributes up to 1/3 of total antibiotic use in major hospitals. With the growing problem of antimicrobial resistance worldwide, it is important to examine the current practice of antibiotic use in surgical prophylaxis. We examined our institution’s experience with vagus nerve stimulator implantation to see how perioperative antibiotic practices impacted postoperative infectious outcomes.
Methods: We conducted a single center case control study with a retrospective chart review of 41 consecutive patients undergoing vagus nerve stimulator (VNS) implantation over 12 months. Patient demographics, perioperative details, and 6 month follow up of infections and healthcare utilization were recorded.
Results: 41 patients underwent VNS implantation at our institution between July 2014 and June 2015. One of two surgeons operated on each patient in the same operating room with the same surgical team, differing by practice preference in choice of antibiotic prophylaxis. Patients either received a single dose of intravenous (IV) cefazolin, or a dose of IV cefazolin and one or both of gentamicin/vancomycin in addition to a 10 day outpatient oral antibiotic course of clindamycin. 24 patients received one dose of peroperative cefazolin as surgical prophylaxis, and 17 patients received =2 perioperative IV antibiotics and PO antibiotics. No patients in either group had VNS implant infection in 6 months following surgery. 8 patients who received only one antibiotic and 6 patients who received =2 antibiotics had other non-implant-related infections in 6 months following VNS placement, ranging from sinusitis to bacteremia. The differences between the two groups in infections (p=1.0) were not significant. There were also no significant differences between the two groups in terms of both inpatient admissions after surgery (p=0.66) and overall seizure control outcome (p=0.11).
Conclusions: Multiple perioperative prophylactic antibiotics did not significantly impact rate of postoperative infection events compared to a single dose of preoperative cefazolin.
Patient Care: Demonstrating recommended use of perioperative antibiotics encourages cost-effective care and addresses antimicrobial resistance.
Learning Objectives: Identify recommended perioperative antibiotic practice for vagus nerve stimulator implantation.
Discuss impact of perioperative antibiotic use.