Prophylactic Antimicrobial Use In Cochlear Implant Surgery In New Zealand
Author's List
Dr Annabel Noakes, Dr Lara Benoiton, Dr Michel Neeff Department of Paediatric Otorhinolaryngology, Starship Hospital, Auckland, NZ Introduction Cochlear implant (CI) surgery is effective in the treatment of severe to profound hearing loss and is associated with a low risk of infection. Postoperative CI infections are however associated with significant cost and hearing implications for patients, possibly requiring reimplantation. With these risks in mind, patients often receive prophylactic antibiotics with wide variation in choice, dosage and length of antimicrobial treatment. |
Presenter: Dr Annabel Noakes
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Aims
The aims of this study were to (i) review the current literature regarding prophylactic antibiotics for CI surgery, (ii) obtain information on current prophylactic antibiotic usage among New Zealand CI surgeons, (iii) propose standardised guidelines in prophylactic antimicrobials in CI surgery.
Methods
A literature search was carried out looking at prophylactic antibiotic usage in CI surgery within Pubmed. An anonymous online survey was sent to the nine CI surgeons within New Zealand to obtain current practice in prophylactic antimicrobial use for CI surgery. Data was also collected from the Southern Cross Gillies Hospital report on antimicrobial use for CI surgery.
Results
Eight of the nine CI surgeons responded to the survey, with one of these surgeons answering questions regarding post operative antibiotic use only. 71% of surgeons used cefazolin as their pre-operative antibiotic, though there was variability in dosage. 71% used clindamycin as their pre-operative antibiotic in patients with a penicillin allergy. There was significant variability in subsequent intraoperative and post-operative antibiotic choices and doses. Based on these results and in consultation with a local infectious diseases representative, we proposed standardised national recommendations for antimicrobial use in CI surgery which are detailed in this study.
Conclusions
While rare, CI surgery infections have significant implications, and prophylactic antibiotics are used in most centres, highlighting the need for a standardised national protocol. A review of outcomes following implementing the recommendations from this study is planned in three months.
The aims of this study were to (i) review the current literature regarding prophylactic antibiotics for CI surgery, (ii) obtain information on current prophylactic antibiotic usage among New Zealand CI surgeons, (iii) propose standardised guidelines in prophylactic antimicrobials in CI surgery.
Methods
A literature search was carried out looking at prophylactic antibiotic usage in CI surgery within Pubmed. An anonymous online survey was sent to the nine CI surgeons within New Zealand to obtain current practice in prophylactic antimicrobial use for CI surgery. Data was also collected from the Southern Cross Gillies Hospital report on antimicrobial use for CI surgery.
Results
Eight of the nine CI surgeons responded to the survey, with one of these surgeons answering questions regarding post operative antibiotic use only. 71% of surgeons used cefazolin as their pre-operative antibiotic, though there was variability in dosage. 71% used clindamycin as their pre-operative antibiotic in patients with a penicillin allergy. There was significant variability in subsequent intraoperative and post-operative antibiotic choices and doses. Based on these results and in consultation with a local infectious diseases representative, we proposed standardised national recommendations for antimicrobial use in CI surgery which are detailed in this study.
Conclusions
While rare, CI surgery infections have significant implications, and prophylactic antibiotics are used in most centres, highlighting the need for a standardised national protocol. A review of outcomes following implementing the recommendations from this study is planned in three months.
