Infezioni di derivazioni ventricolari e profilassi antibiotica

Although several studies have attempted to determine the usefulness of antibiotic prophylaxis in patients undergoing CSF shunt surgery, it is impossible to define exactly its effect on the incidence of infections. Many trials are unsuitable for statistical analysis and the true incidence of different bacterial strains varies from unit to unit. We evaluated 52 cases of CSF shunt infections that occurred in our neurosurgical department in the last five years. On the basis of the strains isolated, we propose an antimicrobial prophylaxis for CSF shunt surgery based on administration of vancomycin 20 mg and amikacin 10 mg in a single dose, instilled directly in the IVT shunt at the time of surgical procedure. We evaluated the rate of infections, the kinetics of the two antibiotics and the incidence of ototoxicity or other neurologic sequelae in nine CSF shunt-surgery patients. We found that the use of vancomycin and amikacin through intraventricular injection is safe and provides 1-20 times the minimum inhibitory concentration for staphylococci.