Antibiotic prophylaxis has revolutionized the safety of neurosurgical procedures in the last century. Today, the clinician's drug of choice before surgery often is based on the antibiotic's resistance profile and drug-induced complications.A decision tree model was developed to compare cefazolin (cephalosporin), vancomycin, or their combination on 90-day mortality postcraniotomy. We modeled the infection type (methicillin-sensitive, methicillin-resistant, or other organisms), antibiotic-related complications that could affect mortality (e.g., renal injury), and Clostridium difficile infections. Parameters' values were extracted from published sources. One-way sensitivity analysis was used to examine results' robustness to plausible variations in input parameter values.The expected value (EV) of 90-day survival was the greatest among patients on cefazolin (EV = 0.9145), followed by patients on vancomycin (EV = 0.8898), and patients on the combination (EV = 0.8886). Cefazolin was the preferred strategy in most one-way sensitivity analyses, except for a few cases in which other options could be preferred based on expected survival. Vancomycin was preferred if kidney injury risk was ≤0.056 conditional on vancomycin intake or ≥12

作者：Amal F, Alotaibi；Rania A, Mekary；Hasan A, Zaidi；Timothy R, Smith；Ankur, Pandya

来源：World neurosurgery 2017 年