Risk Factors for Neurosurgical Site Infections after Craniotomy: A Prospective Multicenter Study of 2944 Patients

Abstract

In reply: I agree with Kanat that we cannot draw any conclusion concerning antibiotic prophylaxis with our observational study, and this was pointed out in the Discussion section of my article. The participating centers were asked not to change any of their habits during the surveillance period. The study thus serves as a real picture of their practice at that time. After reviewing their results, some centers have changed their preoperative protocols regarding hair preparation and/or antibiotic prophylaxis; one center, which did not use an antimicrobial prophylaxis, has decided to initiate one, whereas two other centers changed their protocols and now administer antibiotics only to at-risk patients or during high-risk procedures. These new protocols are under evaluation at the present time. These changes demonstrate the secondary benefits of such studies. Regarding the kind of antibiotics prescribed, most of them (except penicillin G) have been used in randomized neurosurgical studies, with good results versus placebo (1), and have been recommended at an International Conference on the Prevention of Infection(2). No study, to our knowledge, has demonstrated effective concentrations of these antibiotics in the surgical area. Moreover, they are known to poorly cross blood-brain and blood-CSF barriers, but it is assumed that during surgery, there is a disruption of these barriers, allowing antibiotics to penetrate into the surgical field. However, we agree that pharmacological studies of the concentration of these antibiotics in brain and CSF during neurosurgery would be of value, because, in our study, we determined a benefit of antibiotic prophylaxis for the prevention of only incisional infections and not for the prevention of deep wound infections. We do not support the use of third generation cephalosporins for prophylaxis in neurosurgery. They are potent, broad-spectrum antibiotics, of value in the treatment of postoperative meningitis, and their use for 5 days could lead to the development of bacterial resistance in the unit. Anne-Marie Korinek Paris, France