ANTIBIOTIC-PROPHYLAXIS FOR CEREBROSPINAL-FLUID SHUNTS - A METANALYSIS

THE VALUE OF antibiotic prophylaxis for clean neurosurgical procedures without the implantation of a foreign body has been conclusively demo nstrated. Attempts to confirm its efficacy for cerebrospinal fluid shu nt operations have produced confusing and inconclusive results. The ob jective of this study was to combine the results of high-quality contr olled trials of antibiotic prophylaxis for cerebrospinal fluid shunt o perations and to determine if there is evidence for the efficacy of th is policy. Randomized clinical trials identified from presentations at national meetings and in the published literature were subjected to a metanalysis. The pooled data suggest a statistically significant effe ct favoring antibiotic prophylaxis (approximately a 50% reduction in i nfection risk when antibiotic prophylaxis is used). The effect is stro ngly related to the baseline infection rate when prophylaxis is not us ed and disappears when the baseline infection rate is at or below abou t 5%.