Many of the principles underlying the prevention of infection in neurosurgical units are equivalent to those for other surgical specialties, especially those related to surgical site infection (SSI). However, there are some differences in neurosurgical SSIs and other infections, given the nature of the brain, which is confined within the bony cranium, and the fact that many antibiotics do not penetrate well into brain tissue or into the meninges. Furthermore, brain abscess and meningitis/ventriculitis can be devastating illnesses resulting in death or life-long disability. Current controversies include the optimal management of external ventricular drains (EVD), when to remove them, how long to treat when meningitis/ventriculitis occurs, and whether all EVDs should be antibiotic-impregnated. Recent studies suggest that for shunts, antibiotic-impregnated materials result in fewer infections. However, in general, there is a dearth of good clinical trials either in terms of infection prevention measures or for the specific treatment of complex infections such as brain abscess. Consequently, close liaison with neurosurgical colleagues, antimicrobial pharmacists, infection and control practitioners, and others are essential to optimise patient care.

Professor Hilary Humphreys, Consultant Microbiologist, Royal College of Surgeons in Ireland, Dublin