Post-operative
wound infections are a serious complication in neurosurgery. The average
wound infection without
antibiotics ranges between 5-11% in C.S.F. shunts, 2-5% in clean and clean contaminated patients; 11-38% in C.S.F.
fistula. In C.S.F. shunt procedures, common skin commensals are responsible for most post-operative
infections, mainly
coagulase negative and positive staphylococci. Contradictory results of the studies evaluating the efficacy of antibioprophylaxis make it impossible to conclude whether
antibiotics have any impact on the incidence of
infections. Neverless the decision to adopt antibioprophylaxis must be left to each surgeon and based on their own experience (mean level of
infection dropped from 5-11% to 1% with ABP in France). In clean and clean contaminated patients, the weight of evidence based on some large, prospective, randomized studies, suggest that ABP exert a protective effect, for which an antistaphylocci
antibiotic would be appropriate. In case of Methi-R organisms, a
second generation cephalosporin is an alternative candidate. Association of
Vancomycin-
Gentamycin is not recommanded routinely because of the risk of development of resistance. In
skull fracture and C.S.F.
fistula, the results of studies does not favour the routine administration of
antibiotics.