[Prevention of wound infections in neurosurgery]

Post-operative wound infections are a serious complication in neurosurgery. The average wound infection without antibiotics ranges between 5-11% in C.S.F. shunts, 2-5% in clean and clean contaminated patients; 11-38% in C.S.F. fistula. In C.S.F. shunt procedures, common skin commensals are responsible for most post-operative infections, mainly coagulase negative and positive staphylococci. Contradictory results of the studies evaluating the efficacy of antibioprophylaxis make it impossible to conclude whether antibiotics have any impact on the incidence of infections. Neverless the decision to adopt antibioprophylaxis must be left to each surgeon and based on their own experience (mean level of infection dropped from 5-11% to 1% with ABP in France). In clean and clean contaminated patients, the weight of evidence based on some large, prospective, randomized studies, suggest that ABP exert a protective effect, for which an antistaphylocci antibiotic would be appropriate. In case of Methi-R organisms, a second generation cephalosporin is an alternative candidate. Association of Vancomycin-Gentamycin is not recommanded routinely because of the risk of development of resistance. In skull fracture and C.S.F. fistula, the results of studies does not favour the routine administration of antibiotics.