Cleanな脳外科手術における予防的抗生物質投与の有効性—7日間投与と1日投与の比較

Efficacy of Antibiotic Prophylaxis in Clean Neurosurgical Operations : a comparison of seven-day versus one-day administration

I．はじめに

　脳外科手術の多くはclean operationに分類されるが，術後感染は周術期における最も重大な合併症であるため，ほとんどの施設で予防的に抗生物質を投与していると思われる．過去の多くの研究から，抗生物質の予防的投与が術後感染予防に有効であることが示されてきた^2,9,13,16）が，具体的にいつ，何を，どの位の期間投与するかは未だに議論の多い問題であり，特に，どの位の期間投与すべきかを詳細に検討した報告は少ない．これまで当科においては，抜糸までの術後約7日間にわたって抗生物質を投与していたが，今回，術当日のみ投与するプロトコールを設定し，その有効性を検討したので報告する．

We compared seven-day and one-day administration of antibiotics as prophylaxis in clean neurosurgical operations. A total of 175 patients were examined. Seven-day administration (protocol A) was studied re-trospectively from May 1997 to May 1998 in 87 patients of 46 craniotomies and 41 burr hole operations. One-day administration (protocol B) was studied prospectively from June 1998 to July 1999 in 88 patients of 39 craniotomies and 49 burr hole operations. Protocol A received 1.5g of sulbactam/ampicillin=1: 2 (SBT/ABPC) preoperatively, and further doses were continued at 12-hour intervals for seven days after the operation. Protocol B received 1.5g of SBT/ABPC preoperatively and intraoperative additional antibio-tics were administered at 5-hour intervals, and only one single dose was administered after the operation. In both of the protocols, 60mg of tobramycin was mixed with 500ml of saline for irrigation of operative fields. No postoperative infection occurred in either of the two protocols. We conclude that one-day admin-istration of prophylactic antibiotics is enough to prevent postoperative infections in clean neurosurgical operations.