The Role Of Antibiotic Prophylaxis In Shunt Surgery

Objective To determine whether antibiotic prophylaxis(AP)can reduce the postoperative infection rate and identify the risk factors for postoperative infection in shunt surgery.Methods In this study,data were obtained for all elective,deadline and emergency shunt surgeries performed at Tianjin Huanhu Hospital from January 2011 to December 2016.These included shunt operations performed after external ventricular draining,re-shunt surgeries performed after shunt obstruction and shunt surgeries performed to treat hydrocephalus to cure an intracranial infection.All operations were completed by senior doctors in neurosurgery.According to whether prophylactic antibiotics were administered,the cases were divided into prophylactic antibiotic(AP)and non-prophylactic antibiotic(n-AP)groups to evaluate whether there is a significant difference between the two groups.In the AP group,antibiotics were intravenously administered 30 minutes before surgery,and postoperative antibiotics were continued for 72 hours.In the N-AP group,no antibiotics were used both before and after the operation.Postoperative infection was defined as those resulting from CSF shunt infection and surgical incision infection.The symptoms and signs of meningitis or ventriculitis were viewed as indicative of a CSF shunt infection.The United States Centers for Disease Control is adopted as the diagnostic standard for infection.Excel was used to build a database,and the data was analyzed using SPSS version 22(IBM Corp.,Armonk,New York,USA).The risk factors for infection after shunt surgery were analyzed using logistic regression analysis to identify independent risk factors.Results A total of 585 cases of shunt surgery that were performed from January 2011 to December 2016 were reviewed.Of these,2 died of non-intracranial infection within 7 days of the surgery,and 13 cases were absent.Therefore,570 shunt surgery cases were included.There are 321 surgical cases in AP group(21 CSF shunt infections,2 incision infections).The control group consisted of 249 surgical cases(11 CSF shunt infections,0 incision infections).There was no significant difference in postoperative infection after shunt operation between AP group and n-AP group(P=0.170).Bacterial cultures indicated that the postoperative infections in the AP group included 23 cases,of which 12(12/23,52%)were culture-positive,and that the postoperative infections in the n-AP group included 11 cases,of which 10(10/11,91%)were culture-positive(P=0.029).Drug sensitivity tests showed that the rate of resistance in each of the two groups was high.There were 9 cases of multidrug resistance in group AP and 7 such cases in group n-AP.There was no significant difference between the two groups(P=0.525).There was a significant difference between the group with a time gap <6 months and the group with a time gap ?6 months(P=0.038).A logistic regression analysis showed that a history of brain infection(P=0.032;OR,2.588;95% CI,1.088–6.158)and previous ventriculostomy(P=0.049;OR,2.426;95% CI,1.004–5.866)were independent risk factors.Conclusions In our study,a preventive effect of AP on postoperative infection was not observed in shunt surgery.However,AP reduced the rate of positive bacterial cultures.The time gap between the primary brain surgery and the shunt surgery was less than 6 months was more likely to cause postoperative intracranial infection.A logistic regression analysis demonstrated that a history of brain infection and previous ventriculostomy were independent risk factors for postoperative infection and that AP was a non-protective factor.