title: A randomised control trial on the use of topical methicillin in reducing post-operative ventriculoperitoneal shunt infection.
abstract: BACKGROUND
  A double-blind randomised control study was conducted on all patients who were admitted or referred to the Department of Neurosurgery, Sultanah Aminah Hospital, Johor Bahru, with a diagnosis of hydrocephalus where a ventriculoperitoneal shunt was indicated.
  
  
  METHODS
  The period of study was from November 2005 to May 2007, and the follow-up period was 3 months after surgery. Randomisation was carried out in the operating room prior to the procedure. The scrub nurse selected a sealed envelope, which contained the assignment of each patient to 1 of 2 treatment groups: Group 1 patients were treated with topical methicillin, and Group 2 patients were not treated with topical methicillin. Prophylactic antibiotic, cefuroxime (25 mg/kg) was given intravenously at induction. Standard sterile operative technique was followed in preparing and draping the patients.
  
  
  RESULTS
  A total of 90 patients were recruited in the study, and 13 (14.4%) patients developed an infection within 3 months post-operation. Group 1 had a 8.9% risk of infection, and Group 2 had a 20% risk; however, there was no statistically significant post-operative ventriculoperitoneal shunt (VPS) infection reduction with the use of topical methicillin in VPS surgery (P = 0.230). Multivariate analysis showed that only duration of surgery had a significant influence on the incidence of post-operative VPS infection in the non-methicillin group (P = 0.02). The non-methicillin group had an 8 times greater risk of developing post-operative VPS infection than the methicillin group if surgery lasted longer than 1 hour.
  
  
  CONCLUSIONS
  Topical methicillin had no significance in the reduction of post-operative VPS infection.
authors.affiliation: Department of Neurosurgery, Hospital Sultanah Aminah Johor Bahru, 80100 Johor Bahru, Johor, Malaysia.
authors.forename: Sharon Casilda
authors.initials: SC
authors.lastname: Theophilus
authors.forename: Johari Siregar
authors.initials: JS
authors.lastname: Adnan