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Antibiotic prophylaxis during prolonged clean neurosurgery

Results of a randomized double-blind study using oxacillin

Michel Djindjian, Elisabeth Lepresle and Jean-Bernard Homs

T he majority of relevant publications indicate that antibiotic prophylaxis is effective in clean neurosurgery. However, although a recent review by Haines 8 suggests that a “clear and definitive response was given,” we believe that the latest publications leave certain points open to discussion. In 1986, we reported on the efficacy of antibiotic prophylaxis using oxacillin in shunt procedures 6 and suggested the possible extension of prophylaxis with oxacillin for use in clean neurosurgical procedures, excluding operations for shunt placement and patients

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Stephen J. Haines and Michael L. Goodman

W ound infections have long plagued neurosurgeons. Since the enviable record of Cushing, 2 reported neurosurgical infection rates have ranged from 0.7% 9 to 5.7%. 14 When antibiotics became available for clinical use, many surgeons took the logical step of prescribing them before infection occurred in the hope of preventing such infections. Several have retrospectively analyzed their results and suggested that prophylactic antibiotics may be effective. 5, 11, 12 Others have found no benefit or even worsening of infection rates with antibiotic prophylaxis

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Ariane Lewis, Rajeev Sen, Travis C. Hill, Herbert James, Jessica Lin, Harpaul Bhamra, Nina Martirosyan and Donato Pacione

infections such as Clostridium difficile (CDI) 9 , 20 and the growth of resistant bacteria. 5 , 11 , 19 At our institution, the antibiotic prophylaxis protocol for patients with subdural and subgaleal drains was recently changed so that we no longer administer PPSAs to this patient group. In this setting, we sought to retrospectively evaluate the risks and benefits of PPSAs in this population. Our primary objective was to determine whether the discontinuation of PPSAs was associated with an increase in SSIs. Our secondary objectives were to determine if PPSAs

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Göran C. Blomstedt and Juha Kyttä

I n craniotomies, the bone flap is cut off from its blood flow and is therefore comparable to a foreign body, such as a ventricular shunt. Its resistance to infection is reduced, and it may become infected, usually by opportunistic skin bacteria. 4 Prophylactic antimicrobial agents have been found beneficial in shunt surgery, 5 so the aim of this study was to test the usefulness of antimicrobial prophylaxis in patients undergoing craniotomy, with special reference to bone-flap infection. Clinical Material and Methods This trial started on September 1

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Martina Stippler, Elizabeth Crago, Elad I. Levy, Mary E. Kerr, Howard Yonas, Michael B. Horowitz and Amin Kassam

++ . This finding has led researchers to suggest that Mg ++ provides a measure of neuroprotection, even in the presence of cerebral vasospasm, and could explain the trend toward better neurological outcomes in patients treated with magnesium. Conclusions The findings of this study lead us to suggest that continuous MgSO 4 infusion is safe and may play a role in the prophylaxis of cerebral vasospasm. We found a significant reduction in vasospasm and a trend toward improved outcome when continuous MgSO 4 therapy was initiated within 48 hours after aneurysm rupture

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Paul Gutterman and Honorio S. Bezier

. He believed that catgut would swell and occlude the puncture site. This did reduce the incidence of headache but caused a cauda equina syndrome in a large number of the patients. Emory, 7 however, reported failure with this technique. In 1960, Gormley 9 published his initial studies of the use of epidural blood patches and reported immediate and permanent relief of headache after spinal puncture. Since that time other authors have reported similar results. 1, 3, 5, 6 Ozdil and Powell 15 reported prophylaxis of headaches after spinal anesthetic; they injected

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Ronald F. Young and Pablo M. Lawner

T he value of prophylactic antibiotics in the prevention of infections following neurosurgical operative procedures remains a subject of considerable interest. 9–11 Malis' report 15 of 1732 neurosurgical procedures without a single postoperative infection sparked renewed enthusiasm for the use of such prophylaxis. Recently, Geraghty and Feely 8 reported a statistically significant decrease in infections following neurosurgical operations with the use of perioperative prophylactic antibiotics. Tenney, et al. , 18 stressed the potential variability of

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Antibiotic prophylaxis in neurosurgery

A randomized controlled trial

James Geraghty and Micheal Feely

series of more than 1700 cases. No antibiotic regime could guarantee the absence of postoperative infection. However, the extremely low infection rate achieved in our treated group (0.5%) is supportive of Malis' result. The randomization of patients in our study has overcome an important defect in other recent studies, purporting to show a benefit from antibiotics prophylaxis in neurosurgical cases. 1–3 The use of prophylactic antibiotic agents in other branches of surgery has recently been reviewed by Sandusky. 4 while it seems that antibiotic drugs can reduce the

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Seema Bansal, Dan Blalock, Tewodros Kebede, Nathan P. Dean and Jessica L. Carpenter

I ntracranial hemorrhage (ICH) is a risk factor for acute symptomatic seizures. Seizure prophylaxis for prevention of provoked seizures after traumatic brain injury (TBI) is standard practice in children and adults. Prophylaxis in adults is used in other conditions such as subarachnoid hemorrhage; 13 some groups use it following supratentorial neurosurgery as well, 7 although practice guidelines for this use have not yet been established. 9 Previous studies have shown that posttraumatic seizures are more common in children than in adults. 2 Up to 25

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Eli T. Sayegh, Shayan Fakurnejad, Taemin Oh, Orin Bloch and Andrew T. Parsa

administration, 25 significant controversy surrounds the use of perioperative AED prophylaxis for patients undergoing brain tumor resection with no seizure history. 58 A prophylactic drug should only be given if the risk of the adverse outcome (i.e., a seizure) is prominent and the medication is both effective at preventing it and poses an acceptable risk of toxicity. 25 The American Academy of Neurology released practice parameters in 2000 advising against AED prophylaxis in newly diagnosed brain tumor patients due to a lack of efficacy and heightened adverse effects in