Intra-operative wound irrigation with ceftriaxone does not reduce surgical site infection in clean neurosurgical procedures

Abstract

Background The spectrum of post-operative infections in neurosurgical practice includes scalp infection, bone flap osteomyelitis, meningitis and intracranial abscesses and is associated with significant morbidity and mortality. There is a wide variation across neurosurgical centres in the use of perioperative antibiotic prophylaxis. The aim of this study was to determine whether intraoperative wound irrigation with ceftriaxone provides additional prevention of surgical site infection (SSI) in patients already receiving the drug parenterally. Methods This was a prospective randomized clinical study of patients 18 years and above scheduled for clean neurosurgical procedures and assigned to either study or control group using table of random numbers. Both groups had parenteral ceftriaxone at the induction of anaesthesia and for 24-h post-operation. In the study group, there was intra-operative wound irrigation with a ceftriaxone-in-normal saline solution while the wound in the control group was irrigated with only normal saline. Clinical and or laboratory evidence of SSI was used as the outcome measure. Results One hundred and thirty-two patients aged 18 years and above were recruited for this study. There were 66 patients in each group. The overall frequency of SSI was 2.27% (3 out of 132). The frequency in the ceftriaxone group was 3% (2 out of 66) while that in the control group was 1.5% (1 out of 66). These values were not significantly different (p = 1.00). There were four cases of wound edge necrosis, three of which developed SSIs. Conclusion In this study, intraoperative antibiotic irrigation did not confer additional benefit in the prevention of SSI in clean neurosurgical procedures in which prophylactic intravenous antibiotics were administered to the patient. Wound edge necrosis was the most significant but preventable risk factor for the development of SSI in the setting of this work.