[Antibiotic prophylaxis in neurosurgery].
Postoperative wound infections are a serious complication in neurosurgery. The average infection rate without antibiotics ranges between 5-11% in CSF shunts, between 2-5% in craniotomies and spinal surgery in clean and clean contaminated patients, and 11-38% in CSF fistulas. In CSF shunt procedures as well as in craniotomies, common skin commensals, mainly coagulase negative and positive staphylococci are responsible for most postoperative infections. Contradictory results of the studies evaluating the efficacy of prophylactic antibiotics (PA) make it impossible to conclude whether antibiotics have any impact on the incidence of infections or not. Nevertheless the decision to use PA must be left to each surgeon and based on own experience (the mean rate of infection decreased from 5-11% to 1% with PA in France). In clean and clean contaminated surgery, the weight of evidence based on some large, prospective, randomized studies, suggests that PA exerts a protective effect, for which an antistaphylococci antibiotic would be appropriate. In case of methi-R organisms, a second generation cephalosporin is an alternative. Association of vancomycin-gentamicin is not recommended routinely because of the risk of development of resistance.
Djindjian
M
M
Service de Neurochirurgie, Hôpital Henri-Mondor, Créteil.
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001921:Brain / Q000601:surgery*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects; D003399:Craniotomy / Q000009:adverse effects; D006801:Humans; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D013116:Spinal Cord / Q000601:surgery*; D013203:Staphylococcal Infections / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000517:prevention & control*
D000900:Anti-Bacterial Agents
Antibioprophylaxie en neurochirurgie.