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Prophylactic sulfamethoxazole and trimethoprim in ventriculoperitoneal shunt surgery. A double-blind, randomized,
Abstract:
We conducted a randomized, double-blind, placebo-controlled study during a 30-month period to determine whether sulfamethoxazole and trimethoprim would decrease the incidence of infections occurring after ventriculoperitoneal shunt surgery. Of the 120 patients who completed the study according to protocol, 55 received sulfamethoxazole and trimethoprim and 65 received placebo. The incidence of CSF infection in the group receiving sulfamethoxazole and trimethoprim (4/55) was similar to that in the control group (5/65). There was a trend toward earlier identification of infections in the sulfamethoxazole and trimethoprim group (mean, 24.5 days) compared with the control group (mean, 47 days). There was no difference between infected and uninfected patients with respect to frequency of purported risk factors for infection, including history of shunt infection, history of recent myelomeningocele repair, and type and duration of shunt surgery. The incidence of shunt malfunction was similar in uninfected patients receiving antibiotic prophylaxis (18/51) compared with that of patients receiving placebo (23/60). We did not find that the perioperative use of sulfamethoxazole and trimethoprim reduced the incidence of shunt infection or malfunction.
Insights
Perioperative sulfamethoxazole and trimethoprim did not reduce infections after ventriculoperitoneal shunt surgery. While infections were identified earlier in the antibiotic group, overall incidence and shunt malfunction rates were similar to placebo.
Area of Science:
- Neurosurgery
- Infectious Disease Prevention
- Clinical Trials
Background:
- Ventriculoperitoneal shunts are crucial for treating hydrocephalus.
- Shunt infection is a significant complication, potentially leading to revision surgery and increased morbidity.
- Antibiotic prophylaxis is commonly used, but its efficacy in reducing shunt infections requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of perioperative sulfamethoxazole and trimethoprim in preventing cerebrospinal fluid (CSF) infections after ventriculoperitoneal shunt surgery.
- To assess the impact of this antibiotic regimen on shunt malfunction rates.
Main Methods:
- A randomized, double-blind, placebo-controlled study was conducted over 30 months.
- 120 patients undergoing ventriculoperitoneal shunt surgery were included.
- Patients received either sulfamethoxazole and trimethoprim or a placebo perioperatively.
Main Results:
- The incidence of CSF infection was similar between the antibiotic group (4/55) and the placebo group (5/65).
- A trend towards earlier infection detection was observed in the antibiotic group (mean 24.5 days vs. 47 days).
- Shunt malfunction rates were comparable in both groups for uninfected patients.
Conclusions:
- Perioperative use of sulfamethoxazole and trimethoprim did not significantly decrease the incidence of shunt infection or malfunction.
- Risk factors such as prior shunt infection or myelomeningocele repair did not influence infection rates.
- Further research may be needed to optimize antibiotic strategies for shunt surgery prophylaxis.