Determinants of the Effectiveness of Antimicrobial Prophylaxis among Neurotrauma Patients at a Referral Hospital in Kenya: Findings and Implications

Abstract

Background: Surgical site infections can occur adding to morbidity, mortality and costs, and can be particularly problematic in low and middle income countries. This includes infections in neurosurgical patients following surgery despite antimicrobial prophylaxis. The study aimed at measuring the incidence of surgical site infections (SSIs) and identifying factors that influence the effectiveness of antimicrobial prophylaxis in a leading hospital in Kenya. Methods: Prospective cohort study from April to July 2015 in the Neurosurgical ward of a leading referral hospital in Kenya. Adult head injury patients were recruited by universal sampling. Data was collected on prophylactic antibiotics and the occurrence of SSIs. Risk factors for infection were identified by logistic regression. Results: Eighty four patients were recruited, with 69 patients eventually analysed. The incidence of SSIs was 37.7% (n=26). The most common antibiotic used for prophylaxis was ceftriaxone. Patients on prophylaxis were less likely to be infected than those who did not receive prophylaxis; however, this was not statistically significant (RR 0.87, 95% CI 0.40-1.893). The presence of epidural haematoma was a risk factor for the development of SSIs (Crude RR 2.456, 95% CI 1.474-4.090). Overall, antimicrobial prophylaxis was effective only in patients who underwent evacuation of hematoma by craniotomy (risk reduction, 62.5% (CI, 29.0%-96.0%). Conclusion: Evacuation of haematomas through craniotomy increased the effectiveness of prophylaxis, and should be considered in the future. The rationale will be explored further to see if antibiotic prophylaxis can reduce SSIs in other patients with neuro trauma.