The Efficacy of Antibacterial Prophylaxis Against the Development of Meningitis After Craniotomy: A Meta-Analysis

OBJECTIVE: Prophylactic antibiotics are widely used before craniotomy to prevent postoperative infections. A systematic review and meta-analysis was conducted to examine the effect of prophylactic antibiotics on meningitis after craniotomy. METHODS: PubMed, EMBASE, and Cochrane databases were searched through October 2014 for randomized controlled trials that evaluated the effect of prophylactic antibiotics on meningitis after craniotomy. Pooled effect estimates were calculated using fixed-effects and random-effects models. RESULTS: Seven studies with 2365 patients were included in the final analysis. All studies were randomized controlled trials with different antibiotic regimens. Prophylactic antibiotic use reduced the rate of meningitis after neurosurgery, with a pooled Peto odds ratio of 0.34 (95% confidence interval 0.18-0.63). Cochran's Q test indicated no significant heterogeneity among studies (I-2 = 0; P value for heterogeneity = 0.44). Subgroup analysis based on Gram-negative coverage, blinding design, and study quality demonstrated no statistically significant difference among these groups (P> 0.05 for all). A meta-regression on surgery duration (P= 0.52) and on antibiotics duration (P = 0.59) did not show significant differences in the results among studies. CONCLUSIONS: This meta-analysis shows that prophylactic antibiotic use significantly decreases meningitis infections after craniotomy.