Cefepime vs. Ampicillin/Sulbactam and Aztreonam as antibiotic prophylaxis in neurosurgical patients with external ventricular drain: result of a prospective randomized controlled clinical trial.
BACKGROUND
We aimed to find out whether single board spectrum antibiotic prophylaxis was as good as dual specific antibiotic prophylaxis in neurosurgical patients with external ventricular drain (EVD) in situ.


METHODS
In a 2-year period, 255 eligible patients were recruited. Patients were randomized into two groups of antibiotic prophylaxis as long as the ventricular catheter in situ. Group A employed Cefepime 2G 12 hourly and Group B employed dual antibiotics as Ampicillin/Sulbactam 3 g 8 hourly and Aztrenam 2 g 8 hourly.


RESULTS
There was no statistically significant difference in cerebrospinal fluid (CSF) infection rate with 14 patients (11.5%) in group A (Cefepime prophylaxis) and eight patients (6.0%) in group B (dual prophylaxis with Ampicillin/Sulbactam and Aztrenam) had CSF infection (P=0.18). There was also no statistical significant difference between wound infection rate happened in eight patients (6.6%) in Group A and three patients (2.3%) in Group B (P=0.17). There was no statistical significant difference in extracranial infection rate between both groups (P=0.70).


CONCLUSIONS
Single board spectrum antibiotic prophylaxis with Cefepime was an effective alternative regimen for neurosurgical patients with an EVD in situ.
Wong
G K C
GK
Division of Neurosurgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China.
Poon
W S
WS
Lyon
D
D
Wai
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000667:Ampicillin / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001398:Aztreonam / Q000627:therapeutic use*; D000077723:Cefepime; D002511:Cephalosporins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D008997:Monobactams / Q000627:therapeutic use*; D019635:Neurosurgical Procedures; D010406:Penicillins / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D011446:Prospective Studies; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt
D002511:Cephalosporins; D004338:Drug Combinations; D008997:Monobactams; D010406:Penicillins; D000667:Ampicillin; D000077723:Cefepime; D001398:Aztreonam