AB172. SOH26AB_0187. Perioperative antibiotic prophylaxis in neurosurgical procedures: elective cranial and spine surgery at a tertiary neurosurgical centre

Background: Surgical site infections (SSIs) represent 13.6% of all healthcare-associated infections in Ireland. Perioperative antibiotic prophylaxis (ABP) is a key SSI prevention measure. However, excessive or prolonged use offers no added benefit and increases avoidable risks, including adverse drug effects, antimicrobial resistance, and Clostridioides difficile infection. National Antimicrobial Resistance and Infection Control (AMRIC) data show that 25% of prophylactic antibiotics exceeded 24 hours in 2024, surpassing the target of 22%. This audit aimed to evaluate compliance with local antimicrobial prescribing guidelines for ABP in neurosurgical procedures.

Methods: A retrospective observational audit was conducted over a 4-week period. Adult patients undergoing cranial or spinal neurosurgical procedures were included. Exclusions were active infection and incomplete documentation. Compliance was assessed for antibiotic choice, administration within 60 minutes before incision, duration less than 24 hours postoperatively, and adequate documentation for deviation from the guideline.

Results: A total of 51 cases were identified, of which 6 were excluded, leaving 45 for analysis. Median age was 58 years; 24 males and 21 females. Among 19 cranial and 26 spinal operations. Compliance was 98% for correct antibiotic choice, 84% for timing, and 76% for duration <24 h. Fifty-eight percent complied fully with guidelines; non-compliance reflected 11 prolonged ABP courses, 3 missing pneumococcal vaccination following ventriculo-peritoneal shunt (VPS) insertion, and 5 cases without intraoperative prophylaxis. No case included a documented rationale for deviation.

Conclusions: Antibiotic selection and timing were generally guideline-compliant; however, duration and documentation require improvement. Interventions include education and standardised postoperative antimicrobial reviews, with their effectiveness evaluated by reaudit.

Keywords: Antibiotic; prophylaxis; antimicrobial stewardship; compliance; surgical site infection (SSI)