RCT on Topical Methicillin to Reduce VP Shunt Infection Post-Op

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Journal name: The Malaysian Journal of Medical Sciences
Original article title: A Randomised Control Trial on the Use of Topical Methicillin in Reducing Post-Operative Ventriculoperitoneal Shunt Infection
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Original source:

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Author:

Sharon Casilda Theophilus, Johari Siregar Adnan


The Malaysian Journal of Medical Sciences:

(A peer-reviewed, open-access journal)

Full text available for: A Randomised Control Trial on the Use of Topical Methicillin in Reducing Post-Operative Ventriculoperitoneal Shunt Infection

Year: 2011

Copyright (license): CC BY 4.0


Download the PDF file of the original publication


Summary of article contents:

Introduction

A double-blind randomized control study was conducted at Sultanah Aminah Hospital in Johor Bahru from November 2005 to May 2007, targeting patients with hydrocephalus undergoing ventriculoperitoneal shunt (VPS) procedures. The study aimed to evaluate the effectiveness of topical methicillin in reducing the incidence of post-operative infections, a significant complication associated with VPS surgery. A total of 90 patients were included, who were randomized into two groups: one receiving topical methicillin during surgery and the other receiving normal saline as a control. The follow-up period lasted for three months, with a focus on post-operative infection rates.

Efficacy of Topical Methicillin

The results indicated that 14.4% of patients developed post-operative VPS infections, with an infection rate of 8.9% in the methicillin group compared to 20% in the control group. However, the use of topical methicillin did not demonstrate a statistically significant reduction in infection rates (P = 0.230). Multivariate analysis revealed that the duration of surgery was a significant determinant, with non-methicillin patients undergoing surgery for over one hour having an eightfold increased risk of infection compared to the methicillin group. These findings suggest that while topical methicillin appeared to reduce infection rates, the evidence was not strong enough to establish its efficacy definitively, particularly given the influence of surgery duration on infection risk.

Conclusion

In conclusion, this study found that topical methicillin did not significantly reduce post-operative infections in VPS surgery. Although there was a reduction in infections among the methicillin group, the results were not statistically significant, and the primary risk factor identified was the duration of surgery. The findings suggest that further research, potentially involving a larger sample size and extended follow-up periods, is necessary to confirm these results and explore alternative methods to mitigate infection risks in VPS procedures.

FAQ section (important questions/answers):

What was the objective of the study on topical methicillin?

The study aimed to evaluate the effectiveness of topical methicillin in reducing post-operative infection rates in patients undergoing ventriculoperitoneal shunt surgery for hydrocephalus.

What were the infection rates found in the study groups?

The study found that 8.9% of patients in the methicillin group developed infections, compared to 20% in the non-methicillin group, but the difference was not statistically significant.

What factor significantly influenced post-operative VPS infection rates?

Duration of surgery was a significant factor, with surgeries lasting over one hour showing an increased risk of infection, particularly in the non-methicillin group.

What conclusions were drawn regarding the use of topical methicillin?

Topical methicillin did not significantly reduce post-operative infection rates. The study suggests further research with larger sample sizes and longer follow-ups to confirm findings.

Glossary definitions and references:

Scientific and Ayurvedic Glossary list for “RCT on Topical Methicillin to Reduce VP Shunt Infection Post-Op”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.

1) Post:
The term 'Post' refers to the period after a surgical procedure or event. In the context of the study, it indicates the follow-up phase during which patients were monitored for complications, specifically infections after the ventriculoperitoneal shunt surgery. Understanding post-operative outcomes is crucial for evaluating surgical success and determining future protocols.

2) Study (Studying):
The word 'Study' signifies the systematic investigation conducted to assess the effectiveness of topical methicillin in preventing post-operative infections. This research is critical as it contributes to evidence-based practice in neurosurgery and informs clinical guidelines to improve patient outcomes and minimize complications related to shunt surgeries.

3) Table:
In the article, 'Table' refers to structured data representations that summarize findings and analyses, such as infection rates and categorical data comparisons between treatment groups. Tables are essential for presenting complex data clearly, allowing readers to quickly grasp study results and their implications for practice and research in shunt infection prevention.

4) Antibiotic (Antibacterial):
The term 'Antibiotic' refers to substances that inhibit or kill bacteria and are used therapeutically to prevent or treat infections. In this study, topical methicillin, a type of antibiotic, was evaluated for its role in reducing infection rates following ventriculoperitoneal shunt procedures, highlighting the ongoing efforts to mitigate post-operative infections.

5) Developing:
The word ‘Developing’ pertains to the process of growth or progress in a certain area. In the study's context, it relates to the emergence of post-operative infections in patients following surgery. Understanding how infections can develop post-operatively is crucial for implementing preventive strategies and ensuring overall surgical success.

6) Discussion:
The term 'Discussion' outlines the section of the study where results are interpreted, contextualized, and analyzed in relation to existing literature. This part of the paper addresses the findings, their significance, limitations, and implications for future research and clinical practice, facilitating a deeper understanding of study outcomes.

7) Aureus:
The word 'Aureus' specifically refers to Staphylococcus aureus, a type of bacteria known to cause infections, including post-operative shunt infections. Highlighting its role emphasizes the need for effective infection control measures in surgical practice, as Staphylococcus aureus is one of the most common organisms involved in these infections.

8) Malik:
Malik likely refers to a key author or researcher whose work contributed to the existing knowledge on shunt infections and antibiotic use in neurosurgery. Citing Malik's research helps to validate the study's context and situate it within the broader field of surgical infection control literature.

9) Birth:
The term 'Birth' in this study context relates to the neonatal population undergoing ventriculoperitoneal shunt placement. Infants, especially those with congenital hydrocephalus diagnosed at birth, are at heightened risk for post-operative infections. Discussing birth emphasizes the vulnerability of this demographic during surgical interventions.

10) Beta:
The term 'Beta' refers to beta-lactam antibiotics, a class that includes methicillin, which is effective against certain bacterial infections. This classification highlights the pharmacological properties of the antibiotic used in the study, linking its mechanism of action to the prevention of post-operative infections related to shunt placements.

11) Drug:
In the context of the study, 'Drug' relates to methicillin as the primary pharmaceutical agent being evaluated for effectiveness in preventing infection. Understanding its role and application in surgical procedures is essential for determining the best practices in managing post-operative care in neurosurgical patients.

12) Toxicity:
The term 'Toxicity' refers to the harmful effects that a drug can have on the body. The study implicitly addresses this concern regarding the safety profile of topical antibiotics like methicillin during surgical procedures. Assessing the potential toxicity is vital for ensuring patient safety and effective infection control in clinical settings.

13) Incision:
The word 'Incision' refers to the surgical cut made during the operation when placing the ventriculoperitoneal shunt. It is a critical factor in the study as it can influence infection rates. Proper surgical technique surrounding incisions is essential to minimize the risk of introducing pathogens during the procedure.

14) Lakshmi (Laksmi):
Lakshmi likely refers to a prominent researcher or author within the context of surgical infections. Including references to her work emphasizes the collaborative nature of medical research and highlights previous studies and their contributions to the understanding of infection management in neurosurgery.

15) Powder:
The term 'Powder' relates to the methicillin preparation used in the study. Methicillin is provided in powdered form, which must be reconstituted for application. This detail underscores the procedural aspects of employing topical antibiotics and the practical considerations in the operational setting for infection prevention.

16) Cotton:
In surgical practice, 'Cotton' is commonly used for various purposes, including dressing wounds or cleaning surgical sites. Its mention in the study underlines the importance of maintaining sterility and proper handling of materials during surgery to prevent contamination, ultimately reducing the risk of post-operative infections.

17) Indian:
The term 'Indian' may refer to a specific demographic group within the study, highlighting the diversity of the patient population being analyzed. Addressing race and ethnic backgrounds in clinical studies can help identify various risk factors associated with post-operative infections, tailoring approaches to specific groups for better outcomes.

18) Rules:
The word 'Rules' refers to clinical guidelines and protocols that govern surgical procedures and postoperative care. These rules are critical for standardizing practices to minimize infection rates, ensuring a consistent approach to patient management within the context of neurosurgery and the handling of shunt placements.

19) Field:
In this context, 'Field' refers to the surgical field where the ventriculoperitoneal shunt is placed. It is essential to maintain a sterile field during surgery to prevent contamination and infection. Understanding the techniques used to create and maintain a sterile field is crucial in reducing post-operative complications.

20) Masi (Mashi):
Masi possibly denotes another researcher or author whose contributions to the field are referenced within the study. By acknowledging Masi's work, the study situates its findings within the broader academic discourse, reinforcing its credibility and integrating it with existing knowledge regarding shunt infections and management.

21) Nava (Navan):
Nava may refer to a researcher whose studies pertain to drug interactions or antibiotic use in a clinical context. The inclusion of Nava's findings highlights the importance of ongoing research into the effectiveness and safety of pharmaceuticals in surgical practices, particularly regarding infection prevention.

22) Sah:
The term 'Shah' refers to a noted researcher or clinician in the field who's work may influence the study's context. Citing Shah's prior research helps to link the present investigation's findings to broader literature regarding infection management in neurosurgery, enhancing the study's relevance and significance.

23) Life:
In this medical context, 'Life' can refer to the overall health and survival of patients post-surgery. The study emphasizes the importance of successful interventions, such as reducing post-operative infections, in improving the quality of life for patients undergoing ventriculoperitoneal shunt placements.

24) Hair:
The term 'Hair' refers to the associated risk factors during surgery, as pathogens from hair follicles can enter the surgical field and contribute to infections. Addressing hair management protocols before surgery is crucial for maintaining a sterile environment and reducing the incidence of post-operative complications.

25) Coma:
The term 'Coma' designates a state of unresponsiveness commonly assessed pre-operatively using the Glasgow Coma Scale. Patients with a low GCS may be at a higher risk for complications, including infections. This highlights the significance of patient assessment in stratifying surgical risks.

26) Ter:
The term 'Ther' likely stands for Therapeutics, referring to the treatment practices aimed at managing infections or minimizing complications in surgical patients. This relates to the overarching goal of utilizing appropriate treatments, such as antibiotics, to enhance surgical outcomes and patient recovery.

27) Pur:
The term 'Poor' relates to compromised conditions like inadequate skin integrity, which elevate the risk of post-operative infections. Identifying patients with poor conditions is essential for risk assessment and tailoring pre-operative interventions to minimize infection rates in vulnerable populations.

28) Male:
The term 'Male' refers to the gender of patients in the study. While gender does not appear to influence post-operative infection rates substantially, it is essential to report demographic information to contextualize findings and assess any potential bias in clinical outcomes.

Other Science Concepts:

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Discover the significance of concepts within the article: ‘RCT on Topical Methicillin to Reduce VP Shunt Infection Post-Op’. Further sources in the context of Science might help you critically compare this page with similair documents:

Surgical incision, Significant influence, Emergency situation, Data analysis, Sample size, Statistically Significant, Multivariate analysis, Placebo, Confounding factors, Small sample size, Birth weight, Neurosurgery, Chi square test, Pediatric age group, Staphylococcus aureus, Prospective study, Gram positive bacteria, Gestational age, Odds ratio, Confidence interval, Normal saline, Current study, Paediatric age group, Cerebrospinal Fluid, Surgical Site, Control study, Prophylactic Antibiotic, Risk factor, Demographic factors, Surgical technique, Experimental and clinical research, Hydrocephalus, Beta lactam antibiotic, Multiple regression analysis, Post-operative infection, Cochrane review, Randomised study, Fisher's exact test, Risk of infection, Duration of Surgery, Surgeons' experience, Ventriculoperitoneal shunt, Infection rate, Topical antibiotics, Operating room, Aseptic technique, Univariate analysis, Cefuroxime, Significant predictor, Age of Patient, Male and Female Patients, Department of Neurosurgery, Hospital protocol, Burr hole, Clinical factors, Prophylactic dose, Short follow-up period, Serious infection, Sterile Technique, Narrow spectrum, Intrathecal drugs, Infected patient.

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