Abstract
From 1983 to 1987, 140 cranioplasties following decompressive craniectomy were performed. The cranioplasty infection rate was found to be 7% with the prominent organisms being Staphylococcus aureus and Staphylococcus epidermidis (50%). We found that all of these organisms were resistant to the standard therapy of penicillin and first or second generation cephalosporins. We felt that this resistance was secondary to preoperative use of antibiotics.
In a small study of 17 patients, we preoperatively performed skin cultures at surgical site. We found that of the patients who received multiple antibiotics or long term antibiotic therapy (group I), all were found to harbor organisms resistant to penicillin and first or second generation cephalosporins, while there was no resistant organisms found in those patients who were not treated preoperatively with antibiotics or were treated for less than 7 days (group II).
We conclude that preoperative use of antibiotics increases the risk of Staphylococci resistance to standard therapy of penicillin and first or second generation cephalosporins, and that preoperative skin culture taken from the operative site aids in the early identification of resistance
