LAUSR

BACKGROUND Due to direct access through the nasopharyngeal mucosa, endoscopic endonasal (EEA) procedures are inherently contaminated. The reported rate of postoperative meningitis in EEA procedures is 0.7-3%. There are a variety of approaches to minimize the risk of meningitis with antibiotic prophylaxis, although their value is not completely understood. OBJECTIVE To investigate whether there is a difference in rates of postoperative meningitis based on S. aureus colonization and the use of preoperative antibiotic prophylaxis. METHODS All adult patients that underwent an EEA resection at our institution from 2013 to 2021 were retrospectively reviewed. Patients with preoperative CSF infections were excluded. Information including recent preoperative infections, preoperative colonization status, antibiotic administration, and postoperative outcomes were recorded for each patient. RESULTS Four hundred eighty-three patients were identified with a mean age of 51 (range 18-90), of which 274 (56.7%) patients were female. Eighty (16.6%) patients had a positive preoperative MRSA/MSSA screening swab. Twenty-one (26.3%) colonized patients were treated with preoperative decolonizing antibiotics. Within 30 days of surgery, 13 (2.7%) patients developed culture-positive meningitis. There was no significant difference in meningitis rates based on MRSA/MSSA colonization status. Among colonized patients, there was no significant difference in rates of MRSA/MSSA meningitis based on preoperative antibiotic decolonization. CONCLUSION In this study, postoperative rates of meningitis after EEA surgery were not significantly changed based on MRSA/MSSA colonization status of the patient or preoperative decolonization. The utility of preoperative testing of MRSA/MSSA status and antibiotics for decolonization to prevent postoperative meningitis should be further investigated.