Effect of Intravenous Injection with Different Antibiotic Prophylaxis Against the Intracranial Infection after Craniotomy: A Network Meta-Analysis

Background: Many studies had shown that prophylactic use of antibiotics could significantly reduce the postoperative infection rate of craniotomy. However, the best antibiotic selection for intracranial infection (ICI) prevention had not been clearly assessed in previous studies. Objective: To evaluate the effect of various intravenous injection with different antibiotic prophylaxis against the ICI after craniotomy by bayesian network meta-analysis, and to provide references for preventive medication selection in patients undergoing craniotomy. METHODS: An electronic database search was performed, from inception to December 31st 2018. Randomized controlled trials (RCT) using different intravenous antibiotics (IVA) against the ICI after craniotomy were considered. The study selection and data collection were performed independently by two reviewers. Risk of bias assessment was performed using the Cochrane risk of bias scale. The primary outcome was the incidence rates of ICIs. A network meta-analysis was conducted to compare the effect among the different antibiotic prophylaxis to prevent ICIs after craniotomy. Results: A total of 3214 patients after craniotomy in 11 studies were included, 159 patients experienced postoperative ICI, including 33 patients in the antibacterial group and 126 in the control group. The quality of the studies was good. The consistency test showed that there was no obvious inconsistency between the direct and indirect comparison. The calculate results of bayesian network meta-analysis showed that except fusidic acid, preoperative intravenous injection of cephalosporin, clindamycin, vancomycin, and penicillin can significantly reduce the incidence of ICI after craniotomy, but there is no statistical difference among these four antibacterial drugs. Conclusion: The current evidence shows that low-grade antibacterial drugs can be selected to prevent ICI after craniotomy. However, it still need more high-quality, large sample RCT to confirm. Funding Statement: The authors declare: We had no funding support for this study. Declaration of Interests: The authors state: There is no conflict of interest in relation to this study. Ethics Approval Statement: PROSPERO CRD42019133369, All analyses were based on previously published studies, thus no ethical approval or patient consent was required.