Intraoperative Antibiotic Prophylaxis in Neurosurgery: A Prospective Randomized Trial in 840 Patients
The efficacy of a single dose of cefotiam as prophylaxis for postoperative infection was analyzed in a prospective randomized study of 840 patients undergoing either carniotomy (group I, n = 711) or cerebrospinal fluid shunting (group II, n = 129). The main interest was centered on the rate of bone flap infection and shunt sepsis requiring operative revision. Data were evaluated in the total groups and various subgroups formed for high risk patients. Our results show a highly significant difference for postoperative bone flap infection, with 0.3% in the cefotiam group versus 5.1% in the control group (p < 0.001). The overall rate of postoperative deep wound infections including meningitis and abscess (group I) was also significantly different (3.1% vs 9.0%, p < 0.005). This was also true for wound infections in high risk patients (3.1% vs 10.6%) as well as for postoperative sepsis and pneumonia. The overall rate of shunt infections (group II) was 7.5% in the cefotiam group and 12.9% in the control group, with the differences not being statistically significant either for the main group or for high risk subgroups. In summary, antibiotic prophylaxis has proven to be effective for prevention of postoperative infection in patients undergoing craniotomy. Although our results in shunt patients do not reach statistical significance, we also recommend single dose prophylaxis in these cases, since there is a clear difference of infection rate between patients receiving and not receiving the antibiotic.
KeywordsPlacebo Pneumonia Neurol Streptomycin Peri
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