Discontinuing Extended Antimicrobial Prophylaxis Reduces Risk of C Difficile Infections

Alexandria C. Marino, MD, PhD

By reducing the duration of post-surgery antimicrobial prophylaxis, clinicians can reduce the risk of clostridium difficile infections (CDI).

A team, led by Alexandria C. Marino, MD, PhD, Department of Neurological Surgery, University of Virginia, evaluated whether shortening the duration of postprocedural antimicrobial prophylaxis could decrease the rates of C difficile infections without also increasing the incidence of postprocedural infections.

Postprocedural Infections

Postprocedural infections can be consequential following neurosurgical intervention, while periprocedural antimicrobial prophylaxis are routinely administered and continued in some situations for extended periods while the patient has surgical drains in place.

However, there is a lack of research into whether extended antimicrobial administration is necessary to reduce postprocedural infections or if they are associated with an increased risk of infections, including C difficile infections.

Examining the Data

In the retrospective study, the investigators examined a pair of general neurosurgical cohorts. The first trial involved limiting postoperative antimicrobial prophylaxis to 24 hours. The other cohort included some patients who received extended postoperative antimicrobial prophylaxis while surgical drains or external ventricular drains (EVD) remained in place.

The investigators compared rates of CDI and postprocedural infections after surgery and EVD placement.

Overall, there were 7204 patients included in the study who underwent a total of 8586 surgical procedures with 413 EVD placements.

Reducing the Rate of C Difficile

The investigators found C difficile infections decreased significantly from 0.5% per procedure to 0.07% with the discontinuation of extended postprocedural antibiotics within 90 days of a procedure.

On the other hand, the rates of postprocedural infection and EVD infection did not significantly change.

The results were also similar in patients with closes suction drains and cranial and spine subgroups.

“Discontinuation of extended antimicrobial prophylaxis was associated with a significant decrease in the incidence of C. difficile infection without a concomitant change in postprocedural infections or EVD-associated infection,” the authors wrote. “This study provides evidence in support of specialty-wide discontinuation of extended postoperative antimicrobial prophylaxis, even in the presence of closed suction drains.”

Encouraging C Difficile Trends

Last year, investigators found hospitalizations and overall hospital length of stays (LOS) have decreased between 2006-2018 for C difficile infections.

A team, led by Raseen Tariq, MD, Mayo Clinic, examined trends and characteristics of C difficile infection-related hospitalizations between 2006-2018 in data presented during the 2021 American College of Gastroenterology (ACG) Annual Meeting.

Overall, hospital admissions for CDI increased between 2006-2011.

In 2006 admissions were 310,840, compared to 375,770 in 2011, which was the peak of the entire study period.

What followed next was a decline to the overall lowest level in 2018, with 298,930 individuals admitted to the hospital with CDI.

The median age of admission also decreased throughout the study.

For example, the median age of admission was 74 years when the study began in 2006 and steadily declined to 66.26 years in 2018 (P <0.01).

Similar results were found for length of hospital stay, which declined from 12.62 days in 2006 to 9.87 days in 2018 (P <0.01).

In addition, the average length of stay for patients with a primary diagnosis of C difficile infection declined from 7.04 days in 2006 to 5.36 days in 2018 (P <0.01).

The study, “The effects of avoiding extended antimicrobial drain prophylaxis on Clostridioides difficile and postprocedural infection rates: a 5-year retrospective,” was published online in the Journal of Neurosurgery.