Systematic Review, Meta-Analysis and Grading of Evidence on the Effectiveness of Antimicrobial Prophylaxis for Neurosurgical Site Infections
Abstract
Background: Antimicrobial prophylaxis is crucial for neurosurgical procedures, even though they are clean procedures. Observational studies have shown the effectiveness of different antibiotics in preventing neurosurgical site infections, but there remains paucity of systematic reviews and meta-analyses which have assessed their effectiveness in East Africa.
Objectives: To generate and appraise the quality of evidence that would inform antimicrobial prophylaxis in neurosurgery.
Methodology: A systematic review and meta-analysis was conducted between October 2014 and December 2015. Studies that involved the administration of systemic antibiotics for prophylaxis, use of antibiotic impregnated shunt catheters among adult patients aged over 18 years were included and subjected to abstract, title and full text screening. A meta-analysis was carried out using RevMan (Review Manager) version 5 software. The quality of evidence was evaluated using the GRADE system.
Results: One systematic review of randomized controlled trials (n=17) and 11 randomised controlled trials were included in the study. From the first meta-analysis, use of systemic antibiotics demonstrated an overall protective effect of 52% from development of surgical site infections [OR 0.48 (95% CI 0.30, 0.79)]. In the second meta-analysis, the use of antibiotic impregnated shunt catheters was associated with a higher risk of mortality compared to use of the standard shunt [(OR 1.47(95% CI 0.82, 2.62)]. Following evaluation of quality of evidence, in the antibiotics versus placebo arm, the quality of evidence was moderate, while that for antimicrobial impregnated shunts was very low.
Conclusion: Antimicrobial prophylaxis using systemic antibiotics or antimicrobial impregnated shunts is effective in preventing neurosurgical site infections. Antimicrobial impregnated shunts are too expensive for our study population.
Key words: systematic review, meta-analysis, antimicrobial prophylaxis
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