title: The Adjunctive Use of Vancomycin Powder Appears Safe and May Reduce the Incidence of Surgical-Site Infections After Deep Brain Stimulation Surgery.
abstract: BACKGROUND
  Postoperative surgical-site infections (SSIs) are a common complication after deep brain stimulation (DBS) surgery, occurring at a quoted rate of approximately 1%-9%. Intraoperative vancomycin powder has demonstrated efficacy in reducing SSIs after cranial and spinal surgery; however, its use during DBS surgery has yet to be established. In this study, we describe the senior author's experience with the use of intraoperative vancomycin powder to prevent SSIs after DBS surgery.
  
  
  METHODS
  We retrospectively examined the incidence of SSI in 297 patients who underwent DBS surgery at the Mount Sinai Health System from September 2012 to December 2015. All patients underwent a uniform perioperative antiseptic protocol, including thorough skin cleansing, intravenous anticephalosporin antibiotics, copious irrigation, and the application of topical vancomycin powder (1 g) before skin closure. Patient information was obtained through a review of electronic medical records. Primary outcome was the incidence of SSI, which was defined per the standards of the Centers for Disease Control and Prevention and confirmed with wound cultures.
  
  
  RESULTS
  Four patients developed clinical signs and symptoms of SSI (1.3%); all were men with Parkinson disease. The primary organism responsible was Staphylococcus aureus (75%). Two patients presented with neurostimulator infections, and 2 presented with parietal connector-site infections between 2 months and 1 year after initial surgery. No patients in our series developed topical or systemic reactions attributable to the use of vancomycin powder.
  
  
  CONCLUSIONS
  In our experience, vancomycin powder has demonstrated safety and efficacy as an adjunct medication for infection prophylaxis after DBS surgery. Further prospective studies with larger patient cohorts are warranted.
authors.affiliation: Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Rasouli
authors.affiliation: Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA. Electronic address: brian.kopell@mountsinai.org.
authors.forename: Brian Harris
authors.initials: BH
authors.lastname: Kopell
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D019121:Burkholderia Infections / Q000188:drug therapy / Q000453:epidemiology; D016956:Burkholderia cepacia; D002444:Cefuroxime / Q000627:therapeutic use; D046690:Deep Brain Stimulation; D020878:Device Removal; D004318:Doxycycline / Q000627:therapeutic use; D004421:Dystonia / Q000628:therapy; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010300:Parkinson Disease / Q000628:therapy; D011208:Powders; D019919:Prosthesis Implantation; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology; D013211:Staphylococcus aureus; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D014640:Vancomycin / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D011208:Powders; D014640:Vancomycin; D004318:Doxycycline; D002444:Cefuroxime
keywords: DBS; Deep brain stimulation; Infection; SSI; Surgical-site infection; Vancomycin