Shibamura-Fujiogi et al identified risk factors for surgical site infection following neurosurgical procedures to relieve hydrocephalus in pediatric patients. The authors are from Boston Children's Hospital and Harvard Medical School.
Patient selection: pediatric patient with hydrocephalus undergoing a neurosurgical procedure.
Procedure
Frequency SSI
ventriculoperitoneal (VP) shunt
4.3%
external ventricular drain (EVD)
6.9%
endoscopic third ventriculostomy
0%
No risk factors for surgical site infection were identified for external ventricular drain and no SSI were seen with endoscopic third ventriculostomy.
Risk factors for surgical site infection after VP shunt:
(1) prophylaxis with clindamycin (OR 5)
(2) cardiac disease (OR 7.2)
The preferred antibiotic for prophylaxis is cefazolin.
Some patients were given clindamycin because of possible allergy to beta-lactam antibiotics. If a patient has a history of possible beta-lactam antibiotic allergy:
(1) verify the presence of the allergy (use cefazolin if negative)
(2) consult with an infectious disease specialist for an alternative to clindamycin
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