Controversies in the prevention of neurosurgical infection

Amongst post-operative infections, those associated with neurosurgery are of particular significance in view of their proximity to, or location within, the central nervous system. Superficial surgical site infections may be complicated by osteomyelitis of the calvarium and deeper extension to the meninges and cerebral parenchyma. The prevention, diagnosis and management of infections associated with implant devices provide similar challenges to those faced in orthopaedic and cardiac surgery. Whilst some consensus exists regarding the need for antimicrobial prophylaxis in the latter two disciplines, its place in neurosurgery remains controversial. When prophylaxis is considered, choice of antimicrobial agents should take account of up-to-date local information in relation to the relevant microbial ecology in hospitals and in the community setting. The potential for spread of blood-borne virus infections and transmissible spongiform encephalopathies in relation to neurosurgery must also be considered and it should be ensured that appropriate preventive strategies are in place.