title: Prophylactic Effect of Vancomycin on Infection after Cranioplasty in Methicillin-Resistant Staphylococcus Aureus Carriers with Traumatic Brain Injury.
abstract: OBJECTIVE
  Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase negative staphylococci (MRCNS) are major causes of neurosurgical infection. Nasal colonization of MRSA is the most important risk factor and MRSA screening can be a screening method to identify MRSA and MRCNS colonization. We retrospectively evaluated prophylactic effect of vancomycin on MRSA or MRCNS surgical site infection (SSI) after cranioplasty following decompressive craniectomy (DC) after traumatic brain injury (TBI) in MRSA carriers.
  
  
  METHODS
  The study included 21 patients who were positive in MRSA screening before cranioplasty. These patients underwent DC after TBI and subsequent cranioplasty with autologous bone. The patients were separated into SSI group and no SSI group according to the development of SSI due to MRSA or MRCNS after cranioplasty. Mean follow-up period after cranioplasty was 23.5±22.8 months (range, 3 to 73 months). The rate of MRSA or MRCNS SSI and factors including the prophylactic preoperative antibiotics were compared between groups.
  
  
  RESULTS
  The rate of MRSA or MRCNS SSI was 23.8% (5/21 patients). Mean time from cranioplasty to confirm the SSI was 19.6±10.9 days (6 to 63 days). The rate of MRSA or MRCNS SSI was significantly different from the use of preoperative prophylactic antibiotics (p=0.047). MRSA or MRCNS SSI developed in 1 of 13 patients (7.6%) who received vancomycin and in 4 of 8 patients (50%) who received 3rd generation cephalosporin.
  
  
  CONCLUSIONS
  Preoperative MRSA screening and administration of vancomycin as a preoperative prophylactic antibiotic should be considered in MRSA carriers who are scheduled to cranioplasty to reduce MRSA or MRCNS SSI.
authors.affiliation: Department of Neurosurgery, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
authors.forename: Jin Hyuk
authors.initials: JH
authors.lastname: Bang
authors.affiliation: Department of Neurosurgery, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
authors.forename: Keun-Tae
authors.initials: KT
authors.lastname: Cho
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
authors.forename: Seong Yeon
authors.initials: SY
authors.lastname: Park
keywords: Coagulase; Methicillin-resistant Staphylococcus aureus; Staphylococcal infections; Staphylococcus; Surgical wound infection; Vancomycin