• World Neurosurg · Apr 2022

    Review

    The History and Use of Antibiotic Irrigation for Preventing Surgical Site Infection in Neurosurgery: A Scoping Review.

    • Elizabeth Duquette, Pravjit Bhatti, Samir Sur, Daniel R Felbaum, and Ehsan Dowlati.
    • Georgetown University School of Medicine, Washington, DC, USA.
    • World Neurosurg. 2022 Apr 1; 160: 76-83.

    BackgroundSurgical site infections (SSIs) are surgical complications leading to increased antibiotic usage, higher rates of readmission, prolonged hospitalization, and repeat operations. Use of intraoperative antibiotic irrigation as a form of SSI prophylaxis in neurosurgery may have potential. We aim to review the literature surrounding antibiotic irrigation usage in neurosurgical operations to guide current practice and inform future recommendations.MethodsWe performed a scoping review of the literature search on PubMed, Ovid, Cochrane, Web of Science, and ClinicalTrials.gov using the terms: ("Neurosurgery" or "Cranial" or "Spinal") and "Antibiotic" and "Irrigation." Data, results, and conclusions were extracted from these studies, analyzed, and summarized.ResultsSeventeen studies were included. The use of antibiotic irrigation was first popularized in 1979 with the use of streptomycin irrigation by Leonard Malis. Fourteen studies compared SSI rates with a control or historical cohort, and 13 of these studies demonstrated a decrease in SSI rate with antibiotic irrigation. There was greater efficacy of irrigation with vancomycin, gentamicin, or streptomycin use. Results are limited due to variations in choice of antibiotic, type of procedure, instrumentation, and sites of infection across studies. Adverse events based on specific antibiotic use should also be considered.ConclusionsCurrent evidence supports the utility of antibiotic irrigation in preventing neurosurgical SSIs. However, study variability and limitations reduce the generalizability of these results. Given the high morbidity and cost associated with SSIs, randomized control trials are needed to further clarify the best evidence-based practices regarding antibiotic irrigation use in neurosurgical procedures.Copyright © 2022 Elsevier Inc. All rights reserved.

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