Controversies in the prevention of neurosurgical infection

Amongst post-operative infections, those associated with neurosurgery are o f particular significance in view of their proximity to, or location within , the central nervous system. Superficial surgical site infections may be c omplicated by osteomyelitis of the calvarium and deeper extension to the me ninges and cerebral parenchyma. The prevention, diagnosis and management of infections associated with implant devices provide similar challenges to t hose faced in orthopaedic and cardiac surgery. Whilst some consensus exists regarding the need for antimicrobial prophylaxis in the latter two discipl ines, its place in neurosurgery remains controversial. When prophylaxis is considered, choice of antimicrobial agents should take account of up-to-dat e local information in relation to the relevant microbial ecology in hospit als and in the community setting. The potential for spread of blood-borne v irus infections and transmissible spongiform encephalopathies in relation t o neurosurgery must also be considered and it should be ensured that approp riate preventive strategies are in place. (C) 1999 The Hospital Infection S ociety.