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Topical antibiotics in neurosurgery: a re-evaluation of the Malis technique
R S Maurice-Williams1, J Pollock
1Department of Neurosurgery, Royal Free Hospital, London, UK.
Abstract:
We report the effect on the neurosurgical wound infection rate of a modification of the 'Malis' technique of antibiotic prophylaxis. In this a combination of antibiotics is given in the form of both parenteral administration and wound irrigation. A series of 1173 clean neurosurgical operations was compared with a historical control of 303 operations. Both treatment and control groups were operated on by the same surgeon, using similar surgical techniques. The control group received parenteral pre- and postoperative antibiotics (flucloxacillin and ampicillin). The treatment group (where the parenteral antibiotics used was cephradine) also received wound irrigation with a solution of gentamicin and flucloxacilin. The infection rate was 0.42% in the treatment group (five patients), in the control group it was 3.96% (12 patients). The difference was highly significant (p = 0.00006). We believe that the use of wound irrigation with antibiotics should receive further study.
Insights
This study shows that combining parenteral antibiotics with wound irrigation significantly reduces neurosurgical wound infection rates. This modified antibiotic prophylaxis technique offers a promising approach to enhance patient safety in neurosurgery.
Area of Science:
- Neurosurgery
- Infectious Disease Prevention
- Surgical Site Infections
Background:
- Neurosurgical wound infections pose a significant risk to patient outcomes.
- The 'Malis' technique is a recognized method for antibiotic prophylaxis.
- Optimizing antibiotic prophylaxis is crucial for reducing surgical site infections.
Purpose of the Study:
- To evaluate the efficacy of a modified 'Malis' technique for antibiotic prophylaxis in neurosurgery.
- To compare the neurosurgical wound infection rate between a standard prophylaxis group and a modified prophylaxis group.
Main Methods:
- A retrospective study comparing 1173 clean neurosurgical operations with a historical control of 303 operations.
- The control group received parenteral antibiotics (flucloxacillin and ampicillin).
- The treatment group received parenteral cephradine plus wound irrigation with gentamicin and flucloxacillin.
Main Results:
- The modified technique resulted in a significantly lower infection rate (0.42%) compared to the control group (3.96%).
- A statistically significant reduction in infection rate was observed (p = 0.00006).
- Five infections occurred in the treatment group versus twelve in the control group.
Conclusions:
- The modified 'Malis' technique, incorporating antibiotic wound irrigation, substantially decreases neurosurgical wound infection rates.
- Antibiotic wound irrigation is a promising adjunct to parenteral prophylaxis.
- Further research into antibiotic wound irrigation is warranted to validate these findings.
