Randomized clinical trial of intra-operative antimicrobial prophylaxis of infection after neurosurgical procedures

Shapiro, Mervyn; Wald, Uri; Simchen, Elisheva; Pomeranz, Shlomo; Zagzag, David; Michowiz, Shalom; Samuel‐Cahn, Ester; Wax, Yohanan; Shuval, Rivkah; Kahane, Y; Sacks, T.; Shalit, M. N.

doi:10.1016/0195-6701(86)90125-8

Cited by 92 publications

(20 citation statements)

References 12 publications

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“…[558][559][560][561] One such study of patients undergoing craniotomy, spinal, or shunting procedures was stopped early because of an excessive number of SSIs in the placebo group. 562 Choice of agent. Studies of clean neurosurgical procedures reported antimicrobial regimens including clindamycin, 540,543,557 vancomycin, 542,557 cefotiam (not marketed in the United States), 557 piperacillin, 557 cloxacillin, 540,543,557 oxacillin, 542,557 cefuroxime, 547 cefotaxime, 548 sulfamethoxazole-trimethoprim, 548 cefazolin, 542,544 penicillin G, 542 and amoxicillin-clavulanate.…”

Section: Neurosurgery Proceduresmentioning

confidence: 99%

Clinical practice guidelines for antimicrobial prophylaxis in surgery

Bratzler

Dellinger

Olsen

et al. 2013

American Journal of Health-System Pharmacy

1,748

1,336

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Section: Neurosurgery Proceduresmentioning

confidence: 99%

Clinical practice guidelines for antimicrobial prophylaxis in surgery

Bratzler

Dellinger

Olsen

et al. 2013

American Journal of Health-System Pharmacy

1,748

1,336

View full text Add to dashboard Cite

“…Some studies show a beneficial effect of prophylactic antibiotics on the infections secondary to general neurosurgery, and this fact is sometimes used as an argument for introducing prophylactic antibiotics in shunt operation [43,48]. However shunt operations differ from general neurosurgical operations in the placement of a foreign body.…”

Section: Prophylaxis Against Infectionsmentioning

confidence: 98%

Risk of infection after cerebrospinal fluid shunt: An analysis of 884 first-time shunts

et al. 1995

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Postoperative infections are major complications of cerebrospinal fluid (CSF) shunting in the treatment of hydrocephalus and other conditions with obstructed CSF circulation. In a retrospective study 884 first-time shunted patients with hydrocephalus operated on in the years 1958-1989 were investigated with special reference to the infection rate and to the influence of the following variables: time period, age of the patient, education of the neurosurgeon, length and time of the operation and the exact placement of the distal drain. The overall infection rate for all implanted CSF shunts was 7.4% (5.7-9.3%) and the acute rate of infection was 6.2% (4.6-7.9%). The rate of infection was virtually constant for all variables with the exception of the education of the neurosurgeon. Neurosurgical trainees particularly had a significantly higher rate of infection. Shunt infection is still a major complication. The infection rate has not declined in recent decades. It is not possible to relate any main cause to the infection rate. The literature recommends removal of the infected shunt combined with antibiotics. The use of prophylactic antibiotics is still controversial. No prospective, double-blind studies, including a sufficiently large number of patients to evaluate this issue, exist today.

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“…We identified 21 potentially eligible trials, of which 17 were included in the review (Table 2) (3 excluded [36,107,110] and one duplicate citation [77]). We conducted different analyses to reflect the clinical heterogeneity resulting from interventions that are fundamentally different, separating systemic antibiotics from AIS systems and internal shunts from external drains.…”

Section: Resultsmentioning

confidence: 99%

Prophylactic antibiotics and anticonvulsants in neurosurgery

Ratilal

Sampaio

2011

Advances and Technical Standards in Neurosurgery

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The prophylactic administration of antibiotics to prevent infection and the prophylactic administration of anticonvulsants to prevent first seizure episodes are common practice in neurosurgery. If prophylactic medication therapy is not indicated, the patient not only incurs the discomfort and the inconvenience resulting from drug treatment but is also unnecessarily exposed to adverse drug reactions, and incurs extra costs. The main situations in which prophylactic anticonvulsants and antibiotics are used are described and those situations we found controversial in the literature and lack further investigation are identified: anticonvulsants for preventing seizures in patients with chronic subdural hematomas, antiepileptic drugs for preventing seizures in those suffering from brain tumors, antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures, and antibiotic prophylaxis for the surgical introduction of intracranial ventricular shunts.In the following we present systematic reviews of the literature in accordance with the standard protocol of The Cochrane Collaboration to evaluate the effectiveness of the use of these prophylactic medications in the situations mentioned. Our goal was to efficiently integrate valid information and provide a basis for rational decision-making.

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Randomized clinical trial of intra-operative antimicrobial prophylaxis of infection after neurosurgical procedures

Cited by 92 publications

References 12 publications

Clinical practice guidelines for antimicrobial prophylaxis in surgery

Clinical practice guidelines for antimicrobial prophylaxis in surgery

Risk of infection after cerebrospinal fluid shunt: An analysis of 884 first-time shunts

Prophylactic antibiotics and anticonvulsants in neurosurgery

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