Postoperative Antibiotics Following Cochlear Implantation: Are They Necessary?

Objective: Evaluate whether prophylactic antibiotics administered following cochlear implant (CI) surgery impact short-term infection rates. Design: Retrospective, concurrent, case-control. Setting: Tertiary referral center. Patients: All patients (range, 9 months-91 years) undergoing cochlear implantation between 2013 and 2017 (n = 188). Intervention(s): Starting in 2015, one surgeon stopped prescribing postoperative antibiotics after CI surgery. We compared infection rates in a control group that received antibiotics in the 18 months prior to this change (n = 95) to the cohort of patients that did not receive postoperative antibiotics (n = 49). In a second analysis, 44 patients that underwent CI surgery concurrently from a second surgeon and were prescribed postoperative antibiotics were compared to the 49 patients who did not receive postoperative antibiotics. Main Outcome Measure(s): Postoperative infection rates in the perioperative period (0-30 days) following cochlear implantation. Results: None of the 49 cases and none of the 95 historic controls or 44 concurrent controls experienced postoperative infection. Conclusions: In this sample, postoperative antibiotics following cochlear implantation did not impact perioperative infection rates. Unnecessary antibiotics can lead to increased resistance, allergic sequelae, and unnecessary costs while having little effect on reducing infection rates. This pilot study should encourage surgeons to reevaluate standard practice around antibiotic use after CI surgery.