Skip to main content
Log in

Prophylactic antibiotics in pediatric neurological surgery

  • Special Annual Issue
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

Surgical antibiotic prophylaxis (SAP) in pediatric neurosurgery has poorly been characterized until now. This review gives an overview on the current literature extracting recommendations and guidelines.

Methods

The current literature on SAP with special forcus on pediatric neurosurgerical procedures was reviewed. Further, available recommendations in online databases were checked. Clean neurosurgical, shunt, and implant surgeries are considered separately.

Results

To date, evidence-based data on SAP in pediatric neurosurgery remain sparse and there are no standardized approaches to an adequate use of antimicrobial agents for SSI prevention for this age group.

Conclusion

Due to statistical needs, multi-center surveillance studies are needed for implementing SAP recommendations in pediatric neurosurgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

SAP:

Surgical antibiotic prophylaxis

SSI:

Surgical side infection

References

  1. Perencevich EN, Sands KE, Cosgrove SE, Guadagnoli E, Meara E, Platt R (2003) Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis 9:196–203

    Article  PubMed  PubMed Central  Google Scholar 

  2. Plowman R (2000) The socioeconomic burden of hospital acquired infection. Euro Surveill 5:49–50

    Article  PubMed  CAS  Google Scholar 

  3. Woodgate RL, Tailor K, Yanofsky R, Vanan MI (2016) Childhood brain cancer and its psychosocial impact on survivors and their parents: a qualitative thematic synthesis. Eur J Oncol Nurs 20:140–149

    Article  PubMed  Google Scholar 

  4. Davies BM, Jones A, Patel HC (2016) Surgical-site infection surveillance in cranial neurosurgery. Br J Neurosurg 30:35–37

    Article  PubMed  Google Scholar 

  5. Nichols RL (2004) Preventing surgical site infections. Clin Med Res 2:115–118

    Article  PubMed  PubMed Central  Google Scholar 

  6. Karhade AV, Cote DJ, Larsen AM, Smith TR (2017) Neurosurgical infection rates and risk factors: a National Surgical Quality Improvement Program Analysis of 132,000 patients, 2006–2014. World Neurosurg 97:205–212

    Article  PubMed  Google Scholar 

  7. Malis LI (1979) Prevention of neurosurgical infection by intraoperative antibiotics. Neurosurgery 5:339–343

    PubMed  CAS  Google Scholar 

  8. Cruse PJ, Foord R (1980) The epidemiology of wound infection. A 10-year prospective study of 62,939 wounds. Surg Clin North Am 60:27–40

    Article  PubMed  CAS  Google Scholar 

  9. Barker FG 2nd (1994) Efficacy of prophylactic antibiotics for craniotomy: a meta-analysis. Neurosurgery 35:484–490 discussion 491–482

    Article  PubMed  Google Scholar 

  10. Blomstedt GC, Kytta J (1988) Results of a randomized trial of vancomycin prophylaxis in craniotomy. J Neurosurg 69:216–220

    Article  PubMed  CAS  Google Scholar 

  11. Bullock R, van Dellen JR, Ketelbey W, Reinach SG (1988) A double-blind placebo-controlled trial of perioperative prophylactic antibiotics for elective neurosurgery. J Neurosurg 69:687–691

    Article  PubMed  CAS  Google Scholar 

  12. Gaillard T, Gilsbach JM (1991) Intra-operative antibiotic prophylaxis in neurosurgery. A prospective, randomized, controlled study on cefotiam. Acta Neurochir 113:103–109

    Article  PubMed  CAS  Google Scholar 

  13. Geraghty J, Feely M (1984) Antibiotic prophylaxis in neurosurgery. A randomized controlled trial. J Neurosurg 60:724–726

    Article  PubMed  CAS  Google Scholar 

  14. van Ek B, Dijkmans BA, van Dulken H, van Furth R (1988) Antibiotic prophylaxis in craniotomy: a prospective double-blind placebo-controlled study. Scand J Infect Dis 20:633–639

    Article  PubMed  Google Scholar 

  15. Young RF, Lawner PM (1987) Perioperative antibiotic prophylaxis for prevention of postoperative neurosurgical infections. A randomized clinical trial. J Neurosurg 66:701–705

    Article  PubMed  CAS  Google Scholar 

  16. Korinek AM, Golmard JL, Elcheick A, Bismuth R, van Effenterre R, Coriat P, Puybasset L (2005) Risk factors for neurosurgical site infections after craniotomy: a critical reappraisal of antibiotic prophylaxis on 4,578 patients. Br J Neurosurg 19:155–162

    Article  PubMed  Google Scholar 

  17. Korinek AM, Baugnon T, Golmard JL, van Effenterre R, Coriat P, Puybasset L (2006) Risk factors for adult nosocomial meningitis after craniotomy: role of antibiotic prophylaxis. Neurosurgery 59:126–133 discussion 126-133

    Article  PubMed  Google Scholar 

  18. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA (2013) Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 70:195–283

    Article  PubMed  CAS  Google Scholar 

  19. Haley RW, Culver DH, Morgan WM, White JW, Emori TG, Hooton TM (1985) Identifying patients at high risk of surgical wound infection. A simple multivariate index of patient susceptibility and wound contamination. Am J Epidemiol 121:206–215

    Article  PubMed  CAS  Google Scholar 

  20. Kourbeti IS, Jacobs AV, Koslow M, Karabetsos D, Holzman RS (2007) Risk factors associated with postcraniotomy meningitis. Neurosurgery 60:317–325 discussion 325-316

    Article  PubMed  Google Scholar 

  21. Narotam PK, van Dellen JR, du Trevou MD, Gouws E (1994) Operative sepsis in neurosurgery: a method of classifying surgical cases. Neurosurgery 34:409–415 discussion 415–406

    Article  PubMed  CAS  Google Scholar 

  22. Spader HS, Hertzler DA, Kestle JR, Riva-Cambrin J (2015) Risk factors for infection and the effect of an institutional shunt protocol on the incidence of ventricular access device infections in preterm infants. J Neurosurg Pediatr 15:156–160

    Article  PubMed  Google Scholar 

  23. Lee JK, Seok JY, Lee JH, Choi EH, Phi JH, Kim SK, Wang KC, Lee HJ (2012) Incidence and risk factors of ventriculoperitoneal shunt infections in children: a study of 333 consecutive shunts in 6 years. J Korean Med Sci 27:1563–1568

    Article  PubMed  PubMed Central  Google Scholar 

  24. Liu J, Li N, Hao J, Li Y, Liu A, Wu Y, Cai M (2018) Impact of the antibiotic stewardship program on prevention and control of surgical site infection during peri-operative clean surgery. Surg Infect 19:326–333

    Article  Google Scholar 

  25. Classen DC, Evans RS, Pestotnik SL, Horn SD, Menlove RL, Burke JP (1992) The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 326:281–286

    Article  PubMed  CAS  Google Scholar 

  26. van Ek B, Dijkmans BA, van Dulken H, Mouton RP, Hermans J, van Furth R (1990) Effect of cloxacillin prophylaxis on the bacterial flora of craniotomy wounds. Scand J Infect Dis 22:345–352

    Article  PubMed  Google Scholar 

  27. Steinberg JP, Braun BI, Hellinger WC, Kusek L, Bozikis MR, Bush AJ, Dellinger EP, Burke JP, Simmons B, Kritchevsky SB, Trial to Reduce Antimicrobial Prophylaxis Errors Study G (2009) Timing of antimicrobial prophylaxis and the risk of surgical site infections: results from the trial to reduce antimicrobial prophylaxis errors. Ann Surg 250:10–16

    Article  PubMed  Google Scholar 

  28. Ciofi degli Atti M, Spila Alegiani S, Raschetti R, Arace P, Giusti A, Spiazzi R, Raponi M, Group AS (2015) Surgical antibiotic prophylaxis in children: adherence to indication, choice of agent, timing, and duration. Eur J Clin Pharmacol 71:483–488

    Article  PubMed  CAS  Google Scholar 

  29. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K, Reznick RK, Taylor B, Gawande AA, Safe Surgery Saves Lives Study G (2009) A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360:491–499

    Article  PubMed  CAS  Google Scholar 

  30. Oszvald A, Vatter H, Byhahn C, Seifert V, Guresir E (2012) “Team time-out” and surgical safety-experiences in 12,390 neurosurgical patients. Neurosurg Focus 33:E6

    Article  PubMed  Google Scholar 

  31. Tacconelli E, Cataldo MA, Albanese A, Tumbarello M, Arduini E, Spanu T, Fadda G, Anile C, Maira G, Federico G, Cauda R (2008) Vancomycin versus cefazolin prophylaxis for cerebrospinal shunt placement in a hospital with a high prevalence of meticillin-resistant Staphylococcus aureus. J Hosp Infect 69:337–344

    Article  PubMed  CAS  Google Scholar 

  32. Lietard C, Thebaud V, Besson G, Lejeune B (2008) Risk factors for neurosurgical site infections: an 18-month prospective survey. J Neurosurg 109:729–734

    Article  PubMed  Google Scholar 

  33. Whitby M, Johnson BC, Atkinson RL, Stuart G (2000) The comparative efficacy of intravenous cefotaxime and trimethoprim/sulfamethoxazole in preventing infection after neurosurgery: a prospective, randomized study. Brisbane Neurosurgical Infection Group. Br J Neurosurg 14:13–18

    Article  PubMed  CAS  Google Scholar 

  34. Valentini LG, Casali C, Chatenoud L, Chiaffarino F, Uberti-Foppa C, Broggi G (2008) Surgical site infections after elective neurosurgery: a survey of 1747 patients. Neurosurgery 62:88–95 discussion 95-86

    Article  PubMed  Google Scholar 

  35. Barker FG 2nd (2002) Efficacy of prophylactic antibiotic therapy in spinal surgery: a meta-analysis. Neurosurgery 51:391–400 discussion 400-391

    Article  PubMed  Google Scholar 

  36. Barker FG 2nd (2007) Efficacy of prophylactic antibiotics against meningitis after craniotomy: a meta-analysis. Neurosurgery 60:887–894 discussion 887–894

    Article  PubMed  Google Scholar 

  37. Holloway KL, Smith KW, Wilberger JE Jr, Jemsek JG, Giguere GC, Collins JJ (1996) Antibiotic prophylaxis during clean neurosurgery: a large, multicenter study using cefuroxime. Clin Ther 18:84–94

    Article  PubMed  CAS  Google Scholar 

  38. Korinek AM (1997) Risk factors for neurosurgical site infections after craniotomy: a prospective multicenter study of 2944 patients. The French study Group of Neurosurgical Infections, the SEHP, and the C-CLIN Paris-Nord. Service Epidemiologie hygiene et prevention. Neurosurgery 41:1073–1079 discussion 1079-1081

    Article  PubMed  CAS  Google Scholar 

  39. Scher KS (1997) Studies on the duration of antibiotic administration for surgical prophylaxis. Am Surg 63:59–62

    PubMed  CAS  Google Scholar 

  40. Ifeachor AP, Nichols KR, Morris JL, Cox EG, Smith JL, Sinclair EA (2015) Antimicrobial prophylaxis for external ventricular drains in pediatric neurosurgical patients. Paediatr Drugs 17:239–244

    Article  PubMed  Google Scholar 

  41. Raskin JS, Hansen D, Mohan A, Pan IW, Curry DJ, Lam S (2017) Perioperative antibiotic use in vagus nerve stimulator implantation: a clinical series. Childs Nerv Syst 33:801–804

    Article  PubMed  Google Scholar 

  42. Somma T, Maraolo AE, Esposito F, Cavallo LM, Tosone G, Orlando R, Cappabianca P (2015) Efficacy of ultra-short single agent regimen antibiotic chemo-prophylaxis in reducing the risk of meningitis in patients undergoing endoscopic endonasal transsphenoidal surgery. Clin Neurol Neurosurg 139:206–209

    Article  PubMed  Google Scholar 

  43. Liu W, Neidert MC, Groen RJ, Woernle CM, Grundmann H (2014) Third-generation cephalosporins as antibiotic prophylaxis in neurosurgery: what’s the evidence? Clin Neurol Neurosurg 116:13–19

    Article  PubMed  Google Scholar 

  44. Haines SJ, Walters BC (1994) Antibiotic prophylaxis for cerebrospinal fluid shunts: a metanalysis. Neurosurgery 34:87–92

    PubMed  CAS  Google Scholar 

  45. Langley JM, LeBlanc JC, Drake J, Milner R (1993) Efficacy of antimicrobial prophylaxis in placement of cerebrospinal fluid shunts: meta-analysis. Clin Infect Dis 17:98–103

    Article  PubMed  CAS  Google Scholar 

  46. van Lindert EJ, Bilsen MV, Flier MV, Kolwijck E, Delye H, Oever JT (2018) Topical vancomycin reduces the cerebrospinal fluid shunt infection rate: a retrospective cohort study. PLoS One 13:e0190249

    Article  PubMed  PubMed Central  Google Scholar 

  47. Kestle JR, Riva-Cambrin J, Wellons JC 3rd, Kulkarni AV, Whitehead WE, Walker ML, Oakes WJ, Drake JM, Luerssen TG, Simon TD, Holubkov R, Hydrocephalus Clinical Research N (2011) A standardized protocol to reduce cerebrospinal fluid shunt infection: the hydrocephalus clinical research network quality improvement initiative. J Neurosurg Pediatr 8:22–29

    Article  PubMed  PubMed Central  Google Scholar 

  48. Kestle JR, Holubkov R, Douglas Cochrane D, Kulkarni AV, Limbrick DD Jr, Luerssen TG, Jerry Oakes W, Riva-Cambrin J, Rozzelle C, Simon TD, Walker ML, Wellons JC 3rd, Browd SR, Drake JM, Shannon CN, Tamber MS, Whitehead WE, Hydrocephalus Clinical Research N (2016) A new hydrocephalus clinical research network protocol to reduce cerebrospinal fluid shunt infection. J Neurosurg Pediatr 17:391–396

    Article  PubMed  Google Scholar 

  49. Klimo P Jr, Van Poppel M, Thompson CJ, Baird LC, Duhaime AC, Flannery AM, Pediatric Hydrocephalus Systematic R, Evidence-Based Guidelines Task F (2014) Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 6: preoperative antibiotics for shunt surgery in children with hydrocephalus: a systematic review and meta-analysis. J Neurosurg Pediatr 14(Suppl 1):44–52

    Article  PubMed  Google Scholar 

  50. Parker SL, McGirt MJ, Murphy JA, Megerian JT, Stout M, Engelhart L (2015) Comparative effectiveness of antibiotic-impregnated shunt catheters in the treatment of adult and pediatric hydrocephalus: analysis of 12,589 consecutive cases from 287 US hospital systems. J Neurosurg 122:443–448

    Article  PubMed  Google Scholar 

  51. Ratilal B, Costa J, Sampaio C (2008) Antibiotic prophylaxis for surgical introduction of intracranial ventricular shunts: a systematic review. J Neurosurg Pediatr 1:48–56

    Article  PubMed  Google Scholar 

  52. Xu H, Hu F, Hu H, Sun W, Jiao W, Li R, Lei T (2016) Antibiotic prophylaxis for shunt surgery of children: a systematic review. Childs Nerv Syst 32:253–258

    Article  PubMed  CAS  Google Scholar 

  53. Biyani N, Grisaru-Soen G, Steinbok P, Sgouros S, Constantini S (2006) Prophylactic antibiotics in pediatric shunt surgery. Childs Nerv Syst 22:1465–1471

    Article  PubMed  CAS  Google Scholar 

  54. Jaeger W, Lee S, Vineet D, Keil A, Agarwal N, Rao S (2017) Ventriculoperitoneal shunts in neonates: a retrospective study of outcomes with antibiotic-impregnated catheters and a modified peri-operative antibiotic protocol. Br J Neurosurg 31:672–676

    Article  PubMed  Google Scholar 

  55. Govender ST, Nathoo N, van Dellen JR (2003) Evaluation of an antibiotic-impregnated shunt system for the treatment of hydrocephalus. J Neurosurg 99:831–839

    Article  PubMed  Google Scholar 

  56. Sorar M, Er U, Ozisik P, Ozeren E, Simsek S (2014) The impact of antibiotic-impregnated catheters on ventriculoperitoneal shunt infection. Turk J Med Sci 44:393–396

    Article  PubMed  Google Scholar 

  57. Weiss K, Simon A, Graf N, Schope J, Oertel J, Linsler S (2017) Clinical practice audit concerning antimicrobial prophylaxis in paediatric neurosurgery: results from a German paediatric oncology unit. Childs Nerv Syst 33:159–169

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Friederike Knerlich-Lukoschus.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Knerlich-Lukoschus, F., Messing-Jünger, M. Prophylactic antibiotics in pediatric neurological surgery. Childs Nerv Syst 34, 1859–1864 (2018). https://doi.org/10.1007/s00381-018-3864-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-018-3864-0

Keywords

Navigation