Summary
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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Ajir F, Levin AB, Duff TA (1981) Effect of prophylactic methicillin on cerebrospinal fluid shunt infections in children. Neurosurgery 9:6–8
Balch E (1967) Wound infections complicating neurosurgical procedures. J Neurosurg 26:41–45
Blomstedt GC (1985) Infections in neurosurgery. Acta Neurochir (Wien) 78:81–90
Blomstedt GC, Kytta J (1988) Results of a randomized trial of vancomycin prophylaxis in craniotomy. J Neurosurg 69:216–220
Brandt RA, Feres H (1979) Antibiotics profilaticos em neurocirurgia. Arq Neuro-psiquiatr 37:42–47
Bullock R, van Dellen JR, Kelebey W, Reinach SG (1988) A doubleblind placebo-controlled trial of perioperative prophylactic antibiotics for elective neurosurgery. J Neurosurg 69:687–691
Cruse PJE, Foord R (1973) A five-year prospective study of 23,649 surgical wounds. Arch Surg 107:206–210
Dempsey R, Rapp RP, Young B, Johnston S, Tibbs P (1988) Prophylactic parenteral antibiotics in clean neurosurgical procedures: a review. J Neurosurg 69:52–57
Djindjan M, Fevrier MJ, Otterbein G, Soussy JC (1986) Oxacillin prophylaxis in cerebrospinal fluid shunt procedures: results of a randomized open study in 60 hydrocephalic patients. Surg Neurol 25:178–180
Gardner BP, Gordon DS (1982) Postoperative infection in shunts for hydrocephalus: are prophylactic antibiotics necessary? Br Med J 284:1914–1915
Geraghty J, Feely M (1984) Antibiotic prophylaxis in neurosurgery. A randomized controlled trial. J Neurosurg 60:724–726
Haines SJ (1980) Systemic antibiotic prophylaxis in neurological surgery. Neurosurgery 6:355–361
Haines SJ (1989) Efficacy of antibiotic prophylaxis in clean neurosurgical operations. Neurosurgery 24:401–405
Haines SJ, Goodman ML (1982) Antibiotic prophylaxis of postoperative neurosurgical wound infection. J Neurosurg 56:103–105
Malis LI (1979) Prevention of neurosurgical infection by intraoperative antibiotics. Neurosurgery 5:339–343
Mollman HD, Haines S J (1986) Risk factors for neurosurgical wound infection. A case control study. J Neurosurg 64:902–906
Quadery LA, Medlery AV, Miles J (1977) Factors affecting the incidence of wound infection in neurosurgery. Act Neurochir (Wien) 39:133–141
Quartey GRC, Polyzoidis K (1981) Intraoperative antibiotic prophylaxis in neurosurgery: a clinical study. Neurosurgery 8:669–671
Raggueneau JL, Cophiguon J, Kind A, Rey A, Goldstein A, Thurel C, Dematons C, George B, Roux FX (1983) Analyse des suites infectieuses de 1000 interventions neurochirurgicales incidence de l’antibiotherapie prophylactique. Neurochirurgie 29:229–233
Reale F, Biancotti R, De Falco D, Gambacorta D (1987) Antibiotic prophylaxis in neurosurgery. Acta Neurochir (Wien) 86:75–78
Savitz MH, Katz SS (1986) Prevention of primary wound infection in neurosurgical patients: a 10 year study. Neurosurgery 18:685–688
Schoenbaum SC, Gardner BP, Shillito J (1975) Infections of cerebrospinal fluid shunts: epidemiology, clinical manifestations, and their therapy. J Infect Dis 131:543–552
Shapiro M, Wald U, Simchen E, Pomeranz S, Zagzay N, Michowiz SD, Cahn SE, Wax Y, Shuval R, Kahane N, Sacks T, Shilit M (1986) Randomized clinical trial of intra-operative antimicrobial prophylaxis of infection after neurosurgical procedures. J Hosp Infect 8:283–295
Tenney JH, Vlahor D, Salcman M, Ducker T (1985) Wide variations in risk of wound infection following clean neurosurgery. J Neurosurg 62:243–247
Urciuoli R, Russo GL, Zeme S, Canotte M (1983) Traitment antibiotique prophylactique des complications infectieuses postoperatoires en neurochirurgie. Agressologie 24:237 – 238
Van EKG, Bakker FP, van Dulken H, Dijkmans BAC (1986) Infections after craniotomy: a retrospective study. J Infect 12:106–109
Venes JL (1976) Control of shunt infection: report of 150 consecutive cases. J Neurosurg 45:311–314
Wright RL (1966) A survey of possible etiologic agents in postoperative craniotomy infections. J Neurosurg 25:125–132
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1992 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Zentner, J., Gilsbach, J., Gaillard, T. (1992). Intraoperative Antibiotic Prophylaxis in Neurosurgery: A Prospective Randomized Trial in 840 Patients. In: Piscol, K., Klinger, M., Brock, M. (eds) Neurosurgical Standards Cerebral Aneurysms Malignant Gliomas. Advances in Neurosurgery, vol 20. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-77109-5_68
Download citation
DOI: https://doi.org/10.1007/978-3-642-77109-5_68
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-54838-6
Online ISBN: 978-3-642-77109-5
eBook Packages: Springer Book Archive