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Original Investigation
January 2019

Association of the Duration of Antibiotic Therapy With Major Surgical Site Infection in Cochlear Implantation

Author Affiliations
  • 1Otorhinolaryngology and Head and Neck Surgery, Gabriel Montpied University Hospital, Clermont-Ferrand, France
  • 2Otorhinolaryngology, Head and Neck Surgery and Speech and Hearing, Edouard Herriot Hospital, Lyon, France
  • 3University Institute of the Head and Neck, Nice University Hospital, Nice, France
  • 4Lenval-University Pediatric Hospitals of Nice, Nice, France
  • 5Otorhinolaryngology, Otoneurology and Pediatric Otorhinolaryngology, Pierre-Paul Riquet Hospital, Toulouse University Hospital, Toulouse, France
  • 6Otorhinolaryngology and Head and Neck Surgery, Dijon Bourgogne University Hospital, Dijon, France
  • 7Otorhinolaryngology and Head and Neck Surgery, Rouen University Hospital, Rouen, France
  • 8Otorhinolaryngology and Oral and Maxillofacial Surgery, Pontchaillou Hospital, Rennes University Hospital, Rennes, France
  • 9Otorhinolaryngology and Head and Neck Surgery, Nancy University Hospital, Nancy, France
  • 10Department of Statistics, Gabriel Montpied University Hospital, Clermont-Ferrand, France
  • 11Laboratory of Biophysics of Sensory Handicaps, Unité Mixte de Recherche Institut National de la Santé et de la Recherche Médicale 1107, University of Clermont Auvergne, Clermont-Ferrand, France
JAMA Otolaryngol Head Neck Surg. 2019;145(1):14-20. doi:10.1001/jamaoto.2018.1998
Key Points

Question  Is there a difference in major infections after cochlear implantation among patients treated with prolonged antibiotic treatment or treated with only single-dose antibiotic prophylaxis?

Findings  Among 1180 patients in this cohort study, postoperative cochlear implant infection was rare, was less common among those who received prolonged antibiotic treatment vs antibiotic prophylaxis, and was less likely to occur in adults than in children.

Meaning  Prolonged antibiotic treatment is associated with a reduction in postoperative cochlear implant infection risk compared with antibiotic prophylaxis.

Abstract

Importance  Infection after cochlear implantation is a rare but serious event that can lead to meningitis. There is no consensus on prevention of infection in these patients, and each center applies its own strategy.

Objective  To describe the rates of major surgical site infection for patients undergoing cochlear implantation who receive prolonged antibiotic treatment compared with those who receive a single perioperative dose of antibiotic prophylaxis.

Design, Setting, and Participants  Retrospective cohort study of patients who underwent cochlear implantation between January 1, 2011, and July 8, 2015, with a postoperative follow-up of 1 to 3 years. In this multicenter study at 8 French university centers, 1180 patients (509 children and 671 adults) who underwent cochlear implantation during this period were included.

Interventions  Prolonged antibiotic treatment vs single-dose antibiotic prophylaxis.

Main Outcomes and Measures  Major infection and explantation.

Results  Among 1180 patients (509 children [51.7% female] with a mean [SD] age of 4.6 [3.8] years and 671 adults [54.9% female] with a mean [SD] age of 54.8 [17.0] years), 12 patients (1.0%) developed a major infection, with 4 infections occurring in the prolonged antibiotic treatment group and 8 infections occurring in the antibiotic prophylaxis group (odds ratio, 2.45; 95% CI, 0.73-8.17). Children (9 of 509 [1.8%]) were more likely to develop infection than adults (3 of 671 [0.4%]). Among children, 4 infections occurred in the prolonged antibiotic group (n = 344), and 5 infections occurred in the antibiotic prophylaxis group (n = 158) (odds ratio, 2.78; 95% CI, 0.74-10.49). Among adults, 3 infections occurred in the antibiotic prophylaxis group (n = 365), whereas no infections occurred in the prolonged antibiotic treatment group (n = 290).

Conclusions and Relevance  After cochlear implantation, infection was rare, was less common among those who received prolonged antibiotic treatment, and was less likely to occur in adults than in children.

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