Postoperative surgical site infections (SSIs) in neurosurgery remain a significant concern due to their associated high morbidity and mortality. Consequently, implementing the most effective preventive measures is essential. One such strategy, intraoperative antibiotic irrigation, has been widely employed; however, its efficacy continues to be debated. Numerous studies have examined the use of various antibiotics, including streptomycin, bacitracin, gentamicin, rifamycin, amikacin, and vancomycin. Among these, gentamicin has shown promising results in reducing SSI rates, although other antibiotics have also demonstrated potential. Further research is required to determine the most effective method for minimizing SSIs in neurosurgical procedures.

To compare the postoperative outcomes of gentamicin irrigation versus normal saline irrigation in the prevention of surgical site infections (SSIs) in neurosurgical procedures.

A prospective randomized controlled trial was conducted at Rajavithi Hospital between 2023 and 2025. A total of 136 patients were enrolled and randomly assigned, using a block-of-four randomization method, into two groups: the gentamicin irrigation group (n = 68) and the normal saline irrigation group (n = 68). Postoperative surgical site infection (SSI) rates were monitored and statistically analyzed.

A total of 136 patients were included in this study, with 68 patients (50 %) receiving gentamicin irrigation and 68 patients (50 %) receiving normal saline irrigation. There were no statistically significant differences between the two groups in terms of sex, age, body weight, underlying conditions, operative status, complications, operative time, length of hospital stay, or disease type. The postoperative surgical site infection (SSI) rate was 6 % in both groups (4 patients each; p = 0.443). In the gentamicin irrigation group, wound infection grade 3 was observed in 2 patients (3 %), and grade 4 in another 2 patients (3 %). In the normal saline group, 4 patients (6 %) developed grade 4 wound infections.

Gentamicin irrigation did not demonstrate a significant advantage over normal saline irrigation in preventing postoperative surgical site infections when intravenous antibiotics were concurrently administered in neurosurgical patients.