Simple peroperative antimicrobial chemoprophylaxis in elective neurosurgical operations

Abstract From August 1981 to February 1982 postoperative infections due to different strains of penicillin-resistant Staphylococcus aureus occurred in 20 of 467 patients (4·3%) undergoing elective cranial and spinal operations. These infections were not attributable to defects in procedures or the theatre environment, therefore chemoprophylaxis was instituted. In the following 8 months, when patients were given penicillin G and sulphadiazine for 5 days commencing immediately postoperatively, S. aureus infections occurred in five of 579 patients (0·9%). In a subsequent randomized uncontrolled study, infections occurred in six of 265 patients receiving penicillin (2·3%), three of 270 receiving penicillin and sulphadiazine (1-1%) and one of 45 receiving erythromycin (2·2%) immediately postoperatively for 5 days. In a further study in which 587 patients received penicillin for 5 days commencing immediately preoperatively, infections due to S. aureus occurred in six (1·1%). Infections due to gram-negative organisms were seen in five (0·4%) of 1167 patients in the two uncontrolled studies.