Simple peroperative antimicrobial chemoprophylaxis in elective neurosurgical operations

Ingham, H. R.; Kalbag, R. M.; Sisson, P. R.; Allcutt, D; Betty, M.J.; Crawford, P. J. M.; Gillham, Nick; Hankinson, John; Sengupta, R. P.; Strong, A J; Sinar, E J; Crone, Patricia; Gillham, M.; Gould, F.K.; Hudson, S.J.; Wardle, Julie; Cartmill, T.D.I.; Stokes, E.R.

doi:10.1016/0195-6701(88)90011-4

Cited by 8 publications

(5 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In general, postoperative infection rates in clean neurosurgical wounds range from 0.8 to 6% with 3-4% being the expected average rate (29). Prophylactic use of antibiotics in clean neurosurgical operations remains controversial (16,23). Most of the studies published on this subject indicate the use of prophylactic antibiotics in neurosurgical operations (5, 12-14, 17, 23, 28, 29, 32, 38).…”

Section: Discussionmentioning

confidence: 99%

The histopathological and ultrastructural effects of topical application of bacitracin on to the cerebral cortex in rats

Yı́lmaz

Gürer²,

Kertmen³

et al. 2014

Turkish Neurosurgery

View full text Add to dashboard Cite

AIm: Bacitracin is one of the most frequently used agents for the topical irrigation of the cerebral cortex. The aim of this study is to investigate whether bacitracin has histopathological and ultrastructural effects when applied topically to the cerebral cortex. mATErIAl and mEThOds: Twenty-eight rats were randomly assigned to four groups. Except the control group, each rat underwent left frontoparietal craniectomy with dural removal. Then, in the sham group a piece of dry absorbable gelatin sponge was placed over the left hemisphere; in the saline group a gelatin sponge soaked in normal saline; and in the bacitracin group a gelatin sponge soaked in 500 units bacitracin was used. After 48 hours, brain tissues were extracted for histopathological and electron microscopic analyses.rEsulTs: Among the four groups dark stained neurons were found to be statistically higher in number in the bacitracin group compared with the control, sham and saline groups. Electron microscopic evaluation revealed that, in the bacitracin group, almost all cytoplasmic organelles were poorly preserved.CONClusION: Topical application of the bacitracin on to the cerebral cortex caused histopathological and ultrastructural changes in the neural tissue. These changes may be an evidence for the neurotoxic effects of bacitracin.

show abstract

Section: Discussionmentioning

confidence: 99%

The histopathological and ultrastructural effects of topical application of bacitracin on to the cerebral cortex in rats

Yı́lmaz

Gürer²,

Kertmen³

et al. 2014

Turkish Neurosurgery

View full text Add to dashboard Cite

show abstract

“…Table 2 presents five trials on various interventions on prophylaxis of postoperative infections [10, 12, 28, 40, 57]. Limited evidence is provided for the use of antibiotics [57], not to shave the skin [10], and for bactericidal wound irrigation in addition to antibiotics [12].…”

Section: Resultsmentioning

confidence: 99%

“…No difference for complication and reoperation. I = CNo, no, no, noThoracolumbar burst fractures Wood [72], USA ( n = 43)Anterior (I) versus posterior instrumentation (C)Hospitalization, pain, disability, quality of life, return to work, kyphotic angle: I = C. More complications in CNo, no, no, no Wang [64], China ( n = 48)Instrumentation in with bone graft (I), or no bone graft (C)Kyphotic angle, low back pain: I = CNo, no, no, no Korovessis [34], Greece ( n = 47)Combined anterior and posterior (I) versus short segment posterior (C)Radiological and clinical parameters not statistically comparedNo, no, no, noSpinal infections, metastasis, and miscellaneous Ingham [28], England ( n = 662)Prophylactic antibiotics in neurosurgery, mostly laminectomy with or without fusion. Penicillin and sulphonamide (I) versus penicillin (C)Infection rate: I = CNo, no, no, no Young [74], USAPatients with spinal cord compression caused by metastatic cancer laminectomy + radiotherapy (I) vs. radiotherapy (C)Pain, walking ability: I = CNo, no, no, no Albert [2], USA ( n = 57)Early (I) versus late blood autotransfusion (C)Haemoglobin, reticulocyte count, mobilization: I > C. Satisfaction, discomfort, stay at hospital: I = CNo, no, –, no Rubinstein [57], Israel n = 166)Patients undergoing surgery for CLBP and disc degeneration and spinal stenosis.…”

Section: Resultsmentioning

confidence: 99%

The contribution of RCTs to quality management and their feasibility in practice

Brox

2009

Eur Spine J

View full text Add to dashboard Cite

The randomized controlled trial (RCT) is generally accepted as the most reliable method of conducting clinical research. To obtain an unbiased evaluation of the effectiveness of spine surgery, patients should be randomly assigned to either new or standard treatment. The aim of the present article is to provide a short overview of the advantages and challenges of RCTs and to present a summary of the conclusions of the Cochrane Reviews in spine surgery and later published trials in order to evaluate their contribution to quality management and feasibility in practice. From the searches, 130 RCTs were included, 95 from Cochrane Reviews and systematic reviews, and 35 from additional search. No study comparing surgery with sham surgery was identified. The first RCT in spine surgery was published in 1974 and compared debridement and ambulatory treatment in tuberculosis of the spine. The contribution of RCTs in spinal surgery has markedly increased over the last 10 years, which indicates that RCTs are feasible in this field. The results demonstrate missing quality specifications. Despite the number of published trials there is conflicting or limited evidence to support various techniques of instrumentation. The only intervention that receives strong evidence is discectomy for faster relief in carefully selected patients due to lumbar disc prolapse with sciatica. For future trials, authors, referees, and editors are recommended to follow the CONSORT statement. RCTs provide evidence to support clinical opinions before implementation of new techniques, but the individual clinical experience is still important for the doctor who has to face the patient.

show abstract

“…Prophylactic use of antibiotics in clean neurosurgical operations remains controversial, 14,20) but most relat ed studies, which have been instructively reviewed by Brown 4,5) Dempsey et al,10) and Haines,16,17) indicate that it is effective in preventing postoperative infec tions. 2,3,6,[11][12][13]18,20,26,[30][31][32]34,[38][39][40][41]46) Recently, Barkers) and Haines and Walters19) concluded that meta analysis of published randomized studies compar ing prophylactic antibiotics to a placebo showed that antibiotics are advantageous in craniotomies and ventriculoperitoneal shunt operations. Many different antimicrobial agents, alone or in com bination, have been used for this purpose.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of studies have focused on the prophylactic use of antibiot ics'-', [10][11][12][13][14][16][17][18][19][20]25,[29][30][31][32][33][34][35][38][39][40][41]45) as well as the meticulous care, including operative techniques, which must be exercised by all personnel, during and after operative procedures. 8,25,26,35) Perioperative antibiotic administration intended to prevent postoperative neurosurgical infection is not yet widely applied in Japan.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Antimicrobial Prophylaxis in Neurosurgery: Clinical Trial of Systemic Flomoxef Administration and Saline Containing Gentamicin for Irrigation

Yamamoto

Jimbo

Ide

et al. 1996

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

The efficacy of a new protocol consisting of a prophylactic antibiotic regimen of peri- and postoperative intravenous administration of flomoxef and irrigation of the operative field with saline containing gentamicin was assessed by comparing infection rates in two consecutive series of patients who underwent neurosurgical procedures. Group A received postoperative flomoxef administration, with saline containing no antibiotics for irrigation, from July 1988 to December 1989. Group B received the new protocol from January 1990 to December 1991. For further evaluation, this protocol was continued in most patients who underwent surgery from January 1992 through December 1993 (Group C). Only adult or adolescent patients who underwent clean neurosurgical procedures were included. The number of patients and procedures in each group were: 76 patients (97 procedures) in Group A, 103 (133) in Group B, and 107 (137) in Group C. There were no significant differences between Groups A and B in age, sex, clinical category, coexistent disease, clinical outcome, surgical procedures, general anesthesia, emergency operation, steroid administration, and the timing (season), duration, and frequency of surgery. Meningitis developed in three patients and subcutaneous infection in one in Group A. None of the patients in Group B experienced postoperative infection. This difference in infection rates (4.1% vs. 0%) was statistically significant (p = 0.0305). Furthermore, no postoperative infections developed in the Group C patients. The most appropriate interval for multiple dose administration was determined by analyzing intraoperative time-related changes in the serum flomoxef concentration during surgery in 21 recent patients. Serum flomoxef concentrations fell below therapeutic levels (3.0 micrograms/ml) by the 6th post-administration hour in 70% of patients. We conclude that this antibiotic regimen significantly reduces the postoperative infection rate following neurosurgical procedures. Multiple dose administration of flomoxef is recommended when the duration of surgery is 6 hours or more.

show abstract

Simple peroperative antimicrobial chemoprophylaxis in elective neurosurgical operations

Cited by 8 publications

References 16 publications

The histopathological and ultrastructural effects of topical application of bacitracin on to the cerebral cortex in rats

The histopathological and ultrastructural effects of topical application of bacitracin on to the cerebral cortex in rats

The contribution of RCTs to quality management and their feasibility in practice

Perioperative Antimicrobial Prophylaxis in Neurosurgery: Clinical Trial of Systemic Flomoxef Administration and Saline Containing Gentamicin for Irrigation

Contact Info

Product

Resources

About