Antimicrobial prophylaxis with ceftriaxone in neurosurgical procedures. A prospective study of 100 patients undergoing shunt operations.

Shunt infection is a major complication of shunt implantation, with Staphylococcus epidermidis found in almost 45% of infected shunts. This pathogen produces an extracellular slime that enables it to adhere to implantable devices and resist antibiotic therapy. Antimicrobial prophylaxis can prevent slime production. In this paper we report the results of a prospective study involving 100 shunt operations. The objective was to evaluate the efficacy of a single preoperative dose of ceftriaxone (2 g, i.v.) in preventing shunt infection. Ceftriaxone was chosen for its pharmacokinetic properties. No shunt infection was observed over a 4-year follow-up period. On the basis of these results we recommend prophylaxis with ceftriaxone as a safe and effective way of preventing shunt infection. In addition, one-shot prophylaxis with ceftriaxone is more cost-effective than multiple-dose antibiotic regimens.