Prevention of Infections During Neurosurgery

Abstract

Infections associated with neurosurgery can be disastrous. Ample evidence supports the routine use of prophylactic antibacterials in clean, nonimplant neurosurgical procedures to reduce the risk of wound infections. A recently performed meta-analysis suggests that even in neurosurgical units that do not use antibacterial prophylaxis and have a low wound infection rate, prophylaxis may still be beneficial. Since comparative studies are lacking, selection of one prophylactic regimen over another is somewhat arbitrary. In neurosurgical units where the prevailing pathogens are still antibacterial-sensitive Gram-positive cocci, the regimen selected should be aimed at these pathogens. Antistaphylococcal antibacterials, of which the most frequently studied agents are various first or second generation cephalosporins, are suitable for this purpose. Future studies should compare proposed new antibacterial regimens with one of those already demonstrated to be effective.