Comparative Efficacy of Intravenous Cefuroxime and Ceftriaxone in Preventing Surgical Site Infection After Neurosurgical Procedures

BACKGROUND Surgical Site Infection (SSI) is the most common health care-associated infection in hospitalized patients, accounting for 31% of all infections globally.

The prevalence of SSI is determined by the antibiotics prophylaxis, the duration of postoperative monitoring, the institution and the type of surgical procedures. It ranges between 1% and 17% in most surgical specialties. In the Sub-Saharan Africa, the prevalence of SSI following neurosurgical procedures when two different third-generation cephalosporins were used as antibiotic prophylaxis in the same institution were 6.9% and 15% respectively. It is indeed catastrophic, causing poor in-hospital outcomes in upwards of half of those affected and significantly increased their length of hospital stay. SSI following craniotomy costs an average of ₤9,283 above the initial cost of treatment to manage, in addition to the prolonged disablement and reduced functioning of the patient.

Appropriate and timely use of prophylactic antibiotics reduced the prevalence of SSIs from 8.8% to 4.6%. At present, several regimen of antimicrobial agents are used in neurosurgical procedures in the absence of a 'choice' antibiotic agent. The choice, ideal antibiotics should have an appropriate antimicrobial spectrum and favourable pharmacokinetics.

Cephalosporin is among the frequently used antibiotics for prophylaxis in neurosurgical procedures due to its wide spectrum of their effectiveness, good tissue penetration, and the low toxicity of its first and second generation agents. They are bactericidal agents, with a beta-lactam ring structure that determines their antibacterial activity and a six-member dihydrothiazine ring which is responsible for their ability to resist inactivation by certain bacterial enzymes. They have different antibacterial activity based on substitutions at position 7 of the Cephalosporin nucleus. Following penetration of the bacterial cell surface, they attach to bacterial penicillin-binding proteins - proteins thay catalyze critical cell-wall synthesis and division reactions; thus interrupting of bacterial cell-wall synthesis and division.

The first and second-generation Cephalosporins also have the pharmacological advantage that in case of postoperative infection the third and other newer generation Cephalosporin can be given with only a slight chance of developing early resistance.Third generation Cephalosporins, due to their better coverage of gram-negative bacteria compared to the first and second generation agents, have somewhat been put forward since some noticeable change in spectrum toward more gram-negative bacteria has been observed in the microbiological profiles of some series on SSI. Mainly gram-positive cocci; (especially S.aureus and S.epidermidis) are associated with SSI in neurosurgery.