{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T20:26:19Z","timestamp":1792268779413,"version":"4.4.0"},"reference-count":22,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg B Skull Base"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Postoperative prophylactic antibiotic usage for endoscopic skull base surgery varies based on the institution as evidence-based guidelines are lacking. The purpose of this study is to determine whether discontinuing postoperative prophylactic antibiotics in endoscopic endonasal cases led to a difference in central nervous system (CNS) infections, multi-drug resistant organism (MDRO) infections, or other postoperative infections.<\/jats:p><jats:p>\n          Methods\u2003This quality improvement study compared outcomes between a retrospective cohort (from September 2013 to March 2019) and a prospective cohort (April 2019 to June 2019) after adopting a protocol to discontinue prophylactic postoperative antibiotics in patients who underwent endoscopic endonasal approaches (EEAs). Our primary end points of the study included the presence of postoperative CNS infection, Clostridium difficile (C. diff), and MDRO infections.<\/jats:p><jats:p>\n          Results\u2003A total of 388 patients were analyzed, 313 in the pre-protocol group and 75 in the post-protocol group. There were similar rates of intraoperative cerebrospinal fluid leak (56.9 vs. 61.3%, p\u2009=\u20090.946). There was a statistically significant decrease in the proportion of patients receiving IV antibiotics during their postoperative course (p\u2009=\u20090.001) and those discharged on antibiotics (p\u2009=\u20090.001). There was no significant increase in the rate of CNS infections in the post-protocol group despite the discontinuation of postoperative antibiotics (3.5 vs. 2.7%, p\u2009=\u20090.714). There was no statistically significant difference in postoperative C. diff (0 vs. 0%, p\u2009=\u20090.488) or development of MDRO infections (0.3 vs 0%, p\u2009=\u20090.624).<\/jats:p><jats:p>\n          Conclusion\u2003Discontinuation of postoperative antibiotics after EEA at our institution did not change the frequency of CNS infections. It appears that discontinuation of antibiotics after EEA is safe.<\/jats:p>","DOI":"10.1055\/a-1771-0372","type":"journal-article","created":{"date-parts":[[2022,2,15]],"date-time":"2022-02-15T00:44:57Z","timestamp":1644885897000},"page":"157-163","source":"Crossref","is-referenced-by-count":1,"title":["Discontinuation of Postoperative Prophylactic Antibiotics for Endoscopic Endonasal Skull Base Surgery"],"prefix":"10.1055","volume":"84","author":[{"given":"Yosef","family":"Dastagirzada","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, NYU Langone Health, New York, New York, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Benjamin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Miami, Miami, Florida, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Bevilacqua","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, NYU Langone Health, New York, New York, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Gurewitz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, NYU Langone Health, New York, New York, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chandra","family":"Sen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, NYU Langone Health, New York, New York, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4221-0180","authenticated-orcid":false,"given":"John G.","family":"Golfinos","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, NYU Langone Health, New York, New York, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitris","family":"Placantonakis","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, NYU Langone Health, New York, New York, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jafar J.","family":"Jafar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, NYU Langone Health, New York, New York, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth","family":"Lieberman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, NYU Langone Health, New York, New York, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rich","family":"Lebowitz","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, NYU Langone Health, New York, New York, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariane","family":"Lewis","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, NYU Langone Health, New York, New York, United States"},{"name":"Department of Neurology, NYU Langone Health, New York, New York, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donato","family":"Pacione","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, NYU Langone Health, New York, New York, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,3,4]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1086\/657635","article-title":"One thousand endoscopic skull base surgical procedures demystifying the infection potential: incidence and description of postoperative meningitis and brain abscesses","volume":"32","author":"Y Kono","year":"2011","journal-title":"Infect Control Hosp Epidemiol"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/j.wneu.2017.07.075","article-title":"Antibiotic prophylaxis in endoscopic endonasal pituitary and skull base surgery","volume":"106","author":"L Milanese","year":"2017","journal-title":"World Neurosurg"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1177\/0194599811434117","article-title":"Prophylactic perioperative antibiotic use in endoscopic sinus surgery: a systematic review and meta-analysis","volume":"146","author":"A M Saleh","year":"2012","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.2500\/ajra.2016.30.4298","article-title":"Systematic review of the effectiveness of perioperative prophylactic antibiotics for skull base surgeries","volume":"30","author":"S A Rosen","year":"2016","journal-title":"Am J Rhinol Allergy"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.jocn.2017.10.036","article-title":"Antibiotic prophylaxis and infection prevention for endoscopic endonasal skull base surgery: our protocol, results, and review of the literature","volume":"47","author":"S J Johans","year":"2018","journal-title":"J Clin Neurosci"},{"issue":"03","key":"ref6","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1308\/rcsann.2019.0001","article-title":"Risk factors for surgical site infections in neurosurgery","volume":"101","author":"S Patel","year":"2019","journal-title":"Ann R Coll Surg Engl"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"509","DOI":"10.3171\/2013.9.JNS13843","article-title":"Risk factors and outcomes associated with surgical site infections after craniotomy or craniectomy","volume":"120","author":"H-Y Chiang","year":"2014","journal-title":"J Neurosurg"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1007\/s11102-010-0256-1","article-title":"Prophylactic antibiotic trends in transsphenoidal surgery for pituitary lesions","volume":"14","author":"A S Little","year":"2011","journal-title":"Pituitary"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1086\/675828","article-title":"Reduction in Clostridium difficile infections among neurosurgical patients associated with discontinuation of antimicrobial prophylaxis for the duration of external ventricular drain placement","volume":"35","author":"T H Dellit","year":"2014","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"05","key":"ref10","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1007\/s00405-009-1196-0","article-title":"Endoscopic endonasal skull base surgery: past, present and future","volume":"267","author":"P Castelnuovo","year":"2010","journal-title":"Eur Arch Otorhinolaryngol"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1017\/S0022215100103895","article-title":"Meningitis after trans-sphenoidal excision of pituitary tumours","volume":"102","author":"W R Gransden","year":"1988","journal-title":"J Laryngol Otol"},{"issue":"04","key":"ref12","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1002\/j.1930-2398.1988.tb00002.x","article-title":"Craniofacial resection for anterior skull base tumors","volume":"10","author":"N Sundaresan","year":"1988","journal-title":"Head Neck Surg"},{"issue":"03","key":"ref13","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1001\/archotol.1986.03780030093019","article-title":"Toxic shock syndrome after nasal surgery. Case reports and analysis of risk factors","volume":"112","author":"J A Jacobson","year":"1986","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"04","key":"ref14","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1002\/hed.2880130407","article-title":"Antibiotic prophylaxis in cranial base surgery","volume":"13","author":"R L Carrau","year":"1991","journal-title":"Head Neck"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.clineuro.2015.10.007","article-title":"Efficacy of ultra-short single agent regimen antibiotic chemo-prophylaxis in reducing the risk of meningitis in patients undergoing endoscopic endonasal transsphenoidal surgery","volume":"139","author":"T Somma","year":"2015","journal-title":"Clin Neurol Neurosurg"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"908","DOI":"10.3171\/2016.4.JNS16275","article-title":"Antibiotic prophylaxis for subdural and subgaleal drains","volume":"126","author":"A Lewis","year":"2017","journal-title":"J Neurosurg"},{"issue":"03","key":"ref17","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1177\/1941874417748542","article-title":"Discontinuation of postoperative prophylactic antibiotics after noninstrumented spinal surgery: results of a quality improvement project","volume":"8","author":"A Lewis","year":"2018","journal-title":"Neurohospitalist"},{"issue":"04","key":"ref18","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1177\/0194599811411534","article-title":"Association between cerebrospinal fluid leak and meningitis after skull base surgery","volume":"145","author":"G Horowitz","year":"2011","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"02","key":"ref19","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1055\/s-0039-1684034","article-title":"Smoking and obesity are risk factors for thirty-day readmissions following skull base surgery","volume":"81","author":"M Makwana","year":"2020","journal-title":"J Neurol Surg B Skull Base"},{"issue":"02","key":"ref20","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1089\/sur.2016.209","article-title":"Smoking and risk of surgical site infection after spinal surgery: a systematic review and meta-analysis","volume":"18","author":"L Kong","year":"2017","journal-title":"Surg Infect (Larchmt)"},{"issue":"03","key":"ref21","doi-asserted-by":"crossref","first-page":"677","DOI":"10.3171\/2016.2.JNS152345","article-title":"Body habitus, serum albumin, and the outcomes after craniotomy for tumor: a National Surgical Quality Improvement Program analysis","volume":"126","author":"H H Dasenbrock","year":"2017","journal-title":"J Neurosurg"},{"issue":"04","key":"ref22","doi-asserted-by":"crossref","first-page":"e93959","DOI":"10.1371\/journal.pone.0093959","article-title":"Merocel versus Nasopore for nasal packing: a meta-analysis of randomized controlled trials","volume":"9","author":"J Wang","year":"2014","journal-title":"PLoS One"}],"container-title":["Journal of Neurological Surgery Part B: Skull Base"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1771-0372.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,8]],"date-time":"2023-03-08T00:31:30Z","timestamp":1678235490000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1771-0372"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,14]]},"references-count":22,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2023,3,7]]},"published-print":{"date-parts":[[2023,4]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1771-0372","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2193-6331","2193-634X"],"issn-type":[{"value":"2193-6331","type":"print"},{"value":"2193-634X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,2,14]]},"published":{"date-parts":[[2022,2,14]]}}}