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[Local treatment of infections in neurosurgery with gentamicin PMMA chains (Septopal)]
1Neurochirurgische Klinik der Medizinischen Hochschule Hannover.
Abstract:
Treatment of infections after neurosurgical operations at the head and vertebral column is lengthy and stressful for the patient. Hence, we implanted--as has been routine in septic bone surgery for a long time--carriers of antibiotics for local antibiotic therapy in the form of Septopal chains. The course of treatment and the results obtained in 16 patients are presented. In all patients the wound cavities were filled with Septopal chains after débridement. In the course of 6-12 days the chains projecting from the skin by a stab incision were extracted sphere by sphere. The treated wound healed immediately in 14 patients; healing was delayed in 2 patients, but there were no complications. Since the use of Septopal chains results in local gentamicin levels which are so high that the conventional classification of germs into gentamicin-sensitive/gentamicin-resistant is of minor importance, the wounds healed without complications even in those patients where the germs had been classified as "resistant" in the routine antibiogram. Thus, Septopal offers the advantage of primary wound closure without secondary contamination or scatter into the environment (intensive-care ward!), shorter treatment time, reduced stress for the patient and more rapid mobilisation.
Insights
Septopal chains provide effective local antibiotic therapy for neurosurgical infections, leading to faster healing and reduced patient stress. This method ensures high local gentamicin levels, overcoming bacterial resistance and enabling primary wound closure.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Pharmacology
Context:
- Post-neurosurgical infections of the head and vertebral column present significant treatment challenges, often involving lengthy and stressful procedures for patients.
- Local antibiotic delivery is a crucial strategy for managing these deep-seated infections, aiming to achieve high drug concentrations at the infection site.
- Septopal chains, a carrier for local antibiotic therapy, have been routinely used in septic bone surgery.
Purpose:
- To evaluate the efficacy and outcomes of using Septopal chains for local antibiotic therapy in treating post-neurosurgical infections.
Summary:
- Sixteen patients with neurosurgical wound infections underwent débridement followed by the implantation of Septopal chains filled with antibiotics.
- The chains were gradually removed over 6-12 days. Fourteen patients achieved immediate wound healing, with two experiencing delayed healing but no complications.
- High local gentamicin concentrations achieved with Septopal chains rendered conventional antibiotic sensitivity testing less critical, facilitating healing even in cases with resistant bacteria.
Impact:
- Septopal chains facilitate primary wound closure, minimizing secondary contamination and environmental scatter of pathogens.
- This localized antibiotic delivery method reduces treatment duration, alleviates patient stress, and promotes faster mobilization.
- The approach proves effective even against gentamicin-resistant bacteria, offering a significant advantage in managing complex neurosurgical infections.