Gunnarut Ittipon, Buakate Kritsada, Phatisuwan Nisarat
Neurosurgical Unit, Department of Surgery, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand.
OPD Referral Center, Rajavithi Hospital, Bangkok, Thailand.
Clin Neurol Neurosurg. 2025 Jul 5;257:109045. doi: 10.1016/j.clineuro.2025.109045.
Postoperative surgical site infections (SSIs) in neurosurgery remain a significant concern due to their associated high morbidity and mortality. Consequently, implementing the most effective preventive measures is essential. One such strategy, intraoperative antibiotic irrigation, has been widely employed; however, its efficacy continues to be debated. Numerous studies have examined the use of various antibiotics, including streptomycin, bacitracin, gentamicin, rifamycin, amikacin, and vancomycin. Among these, gentamicin has shown promising results in reducing SSI rates, although other antibiotics have also demonstrated potential. Further research is required to determine the most effective method for minimizing SSIs in neurosurgical procedures.
To compare the postoperative outcomes of gentamicin irrigation versus normal saline irrigation in the prevention of surgical site infections (SSIs) in neurosurgical procedures.
A prospective randomized controlled trial was conducted at Rajavithi Hospital between 2023 and 2025. A total of 136 patients were enrolled and randomly assigned, using a block-of-four randomization method, into two groups: the gentamicin irrigation group (n = 68) and the normal saline irrigation group (n = 68). Postoperative surgical site infection (SSI) rates were monitored and statistically analyzed.
A total of 136 patients were included in this study, with 68 patients (50 %) receiving gentamicin irrigation and 68 patients (50 %) receiving normal saline irrigation. There were no statistically significant differences between the two groups in terms of sex, age, body weight, underlying conditions, operative status, complications, operative time, length of hospital stay, or disease type. The postoperative surgical site infection (SSI) rate was 6 % in both groups (4 patients each; p = 0.443). In the gentamicin irrigation group, wound infection grade 3 was observed in 2 patients (3 %), and grade 4 in another 2 patients (3 %). In the normal saline group, 4 patients (6 %) developed grade 4 wound infections.
Gentamicin irrigation did not demonstrate a significant advantage over normal saline irrigation in preventing postoperative surgical site infections when intravenous antibiotics were concurrently administered in neurosurgical patients.
神经外科手术后手术部位感染（SSIs）因其高发病率和死亡率仍是一个重大问题。因此，采取最有效的预防措施至关重要。术中抗生素冲洗就是这样一种策略，已被广泛应用；然而，其疗效仍存在争议。众多研究考察了各种抗生素的使用，包括链霉素、杆菌肽、庆大霉素、利福霉素、阿米卡星和万古霉素。其中，庆大霉素在降低手术部位感染率方面显示出有前景的结果，尽管其他抗生素也显示出了潜力。需要进一步研究以确定在神经外科手术中使手术部位感染最小化的最有效方法。
比较庆大霉素冲洗与生理盐水冲洗在预防神经外科手术中手术部位感染（SSIs）的术后结果。
2023年至2025年在拉贾维提医院进行了一项前瞻性随机对照试验。共纳入136例患者，采用四人一组的随机分组方法将其随机分为两组：庆大霉素冲洗组（n = 68）和生理盐水冲洗组（n = 68）。对术后手术部位感染（SSI）率进行监测并进行统计学分析。
本研究共纳入136例患者，68例（50%）接受庆大霉素冲洗，68例（50%）接受生理盐水冲洗。两组在性别、年龄、体重、基础疾病、手术状态、并发症、手术时间、住院时间或疾病类型方面无统计学显著差异。两组术后手术部位感染（SSI）率均为6%（每组4例；p = 0.443）。庆大霉素冲洗组中，2例患者（3%）出现3级伤口感染，另外2例患者（3%）出现4级伤口感染。生理盐水组中，4例患者（6%）出现4级伤口感染。
在神经外科患者同时使用静脉抗生素时，庆大霉素冲洗在预防术后手术部位感染方面未显示出比生理盐水冲洗有显著优势。
