The Use of Vancomycin Powder for Surgical Prophylaxis Following Craniotomy.
BACKGROUND
Intrawound vancomycin powder has been studied extensively in spinal fusion surgeries and been found to reduce rates of surgical site infections (SSIs) significantly. Despite its success in spinal surgeries, topical vancomycin has not been extensively studied with respect to cranial neurosurgery.


OBJECTIVE
To evaluate the efficacy of intrawound topical vancomycin for prevention of SSIs following open craniotomies.


METHODS
We retrospectively analyzed a large series of 350 patients from 2011 to 2015 in a pre/postintervention study of use of topical vancomycin to reduce postoperative craniotomy infection rates. We had a preintervention control group of 225 patients and a postintervention group of 125 patients that received intrawound topical vancomycin.


RESULTS
Our preintervention incidence of SSI was 2.2% and this was significantly reduced to 0% following introduction of topical vancomycin ( P < .5). An ad hoc cost analysis suggested a cost savings of ${\$}$ 59 965 with the use of topical vancomycin for craniotomies.


CONCLUSIONS
Our study found a significant reduction in SSI rates after introduction of topical vancomycin. Thus, this simple intervention should be considered in all open craniotomy patients as both infection prophylaxis and a potential cost saving intervention.
Department of Neurosurgery, Stanford School of Medicine, Stanford, California.|New York Medical College, Valhalla, New York.
Vinod
V
Ravikumar
Department of Neurosurgery, Stanford School of Medicine, Stanford, California.
Allen L
AL
Ho
Department of Neurosurgery, Stanford School of Medicine, Stanford, California.
Arjun V
AV
Pendhakar
Department of Neurosurgery, Stanford School of Medicine, Stanford, California.
Eric S
ES
Sussman
Department of Neurosurgery, Stanford School of Medicine, Stanford, California.
Kevin
K
Kwong-Hon Chow
Department of Neurosurgery, Stanford School of Medicine, Stanford, California.
Gordon
G
Li
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics; D019072:Antibiotic Prophylaxis / Q000191:economics / Q000379:methods*; D015331:Cohort Studies; D017046:Cost Savings / Q000191:economics; D003399:Craniotomy / Q000009:adverse effects* / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011208:Powders; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D014640:Vancomycin / Q000008:administration & dosage* / Q000191:economics
D000900:Anti-Bacterial Agents; D011208:Powders; D014640:Vancomycin
Antibiotics; Infection prophylaxis; Surgical prophylaxis; Surgical site infection; Topical vancomycin; Vancomycin powder; craniotomy infection