Duration of single-agent perioperative antibiotic prophylaxis and postoperative meningitis after endoscopic endonasal skull base surgery: a systematic review and meta-analysis of 7,981 patients.

In 30 seconds

This systematic review and meta-analysis examined postoperative meningitis after endoscopic endonasal skull-base surgery in 7,981 patients across 14 studies using single-agent perioperative antibiotic prophylaxis. The pooled meningitis incidence was 1.38% (95% CI: 0.92%-2.08%; I² = 65.8%). Incidence did not differ significantly across long-, short-, and ultra-short-duration protocols, and meta-regression found no association between antibiotic duration and meningitis. A higher study-level proportion of intraoperative CSF leaks was associated with higher meningitis incidence.

Key findings

• Pooled postoperative meningitis incidence was 1.38% (95% CI: 0.92%-2.08%; I² = 65.8%).
• Incidence was 2.12% with long-duration, 1.20% with short-duration, and 1.24% with ultra-short prophylaxis; subgroup difference p = 0.764.
• Antibiotic duration was not associated with meningitis in meta-regression (p = 0.487).
• A higher study-level proportion of intraoperative CSF leaks was associated with higher meningitis incidence (β = 0.0389 per percentage point on the logit scale; p = 0.010).

Why it matters

Meningitis was uncommon in the included cohorts, and the analysis did not detect a relationship between prophylaxis duration and its incidence. The association with intraoperative CSF leak prevalence highlights operative risk characteristics as potentially relevant to infection risk. These findings help frame the uncertainty around antibiotic duration while underscoring that the evidence is based on study-level comparisons.

What to keep in mind

The analysis synthesizes study-level proportions, and heterogeneity in meningitis incidence was substantial (I² = 65.8%). The duration comparison showed no statistically significant difference, which does not establish equivalence between protocols.