Wesley Shoap, Robert C Osorio, Armond Esmaili, Philip Theodosopoulos, Shawn L Hervey-Jumper, Ezequiel Goldschmidt
{"title":"Efficacy of Vancomycin Powder Prophylaxis in 987 Cranial Surgeries for Nonmalignant Pathology.","authors":"Wesley Shoap, Robert C Osorio, Armond Esmaili, Philip Theodosopoulos, Shawn L Hervey-Jumper, Ezequiel Goldschmidt","doi":"10.1227/neu.0000000000003692","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>The use of prophylactic subgaleal vancomycin powder for preventing surgical site infections (SSI) has gained traction among cranial surgeons. However, its broad application remains controversial as the studies supporting its use are skewed toward high infection risk pathologies and have significant limitations. This study aimed to evaluate the efficacy of vancomycin powder in reducing SSIs in a cohort of patients with nonmalignant cranial pathologies.</p><p><strong>Methods: </strong>A retrospective chart review was conducted for 987 patients who underwent cranial surgeries for nonmalignant pathologies between July 2021 and June 2024 at a major academic center. Patients were divided into 2 groups: those who received prophylactic vancomycin powder (682 patients) and those who did not (305 patients). Data on demographics, comorbidities, procedure types, and SSI occurrences were collected.</p><p><strong>Results: </strong>Established infection risk characteristics were nonsignificantly different between groups. There was no significant SSI difference when comparing patients not receiving vancomycin vs those who received the antibiotic (0.3% vs 0.7%, P = .578). There were 6 infections in total, 3/6 (50%) occurred with atypical meningiomas, 2/6 (33%) occurred with schwannomas, and 1/6 (17%) occurred with an amoebic abscess. Supratentorial craniotomies (odds ratio 0.95, P = .810) and posterior fossa craniotomies (odds ratio 1.18, 0.545) were the most common procedures and were nonsignificantly different between the cohorts. Meningiomas represented the largest portion of pathologies and were equally represented in both groups.</p><p><strong>Conclusion: </strong>This study suggests that the routine use of prophylactic vancomycin powder in nonmalignant cranial surgeries may be unnecessary, given an overall low incidence and lack of significant difference in SSIs between groups. These findings advocate for a more tailored approach to antibiotic prophylaxis, weighing the potential benefits against the known risks.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9000,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1227/neu.0000000000003692","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background and objectives: The use of prophylactic subgaleal vancomycin powder for preventing surgical site infections (SSI) has gained traction among cranial surgeons. However, its broad application remains controversial as the studies supporting its use are skewed toward high infection risk pathologies and have significant limitations. This study aimed to evaluate the efficacy of vancomycin powder in reducing SSIs in a cohort of patients with nonmalignant cranial pathologies.
Methods: A retrospective chart review was conducted for 987 patients who underwent cranial surgeries for nonmalignant pathologies between July 2021 and June 2024 at a major academic center. Patients were divided into 2 groups: those who received prophylactic vancomycin powder (682 patients) and those who did not (305 patients). Data on demographics, comorbidities, procedure types, and SSI occurrences were collected.
Results: Established infection risk characteristics were nonsignificantly different between groups. There was no significant SSI difference when comparing patients not receiving vancomycin vs those who received the antibiotic (0.3% vs 0.7%, P = .578). There were 6 infections in total, 3/6 (50%) occurred with atypical meningiomas, 2/6 (33%) occurred with schwannomas, and 1/6 (17%) occurred with an amoebic abscess. Supratentorial craniotomies (odds ratio 0.95, P = .810) and posterior fossa craniotomies (odds ratio 1.18, 0.545) were the most common procedures and were nonsignificantly different between the cohorts. Meningiomas represented the largest portion of pathologies and were equally represented in both groups.
Conclusion: This study suggests that the routine use of prophylactic vancomycin powder in nonmalignant cranial surgeries may be unnecessary, given an overall low incidence and lack of significant difference in SSIs between groups. These findings advocate for a more tailored approach to antibiotic prophylaxis, weighing the potential benefits against the known risks.
背景和目的：在颅外科医生中，使用预防性的半galal下万古霉素粉末预防手术部位感染（SSI）已经得到了广泛的关注。然而，它的广泛应用仍然存在争议，因为支持其使用的研究倾向于高感染风险的病理，并且具有显着的局限性。本研究旨在评估万古霉素粉末在减少非恶性颅脑病变患者ssi中的疗效。方法：对某大型学术中心于2021年7月至2024年6月期间因非恶性病变接受颅脑手术的987例患者进行回顾性图表分析。患者分为预防性万古霉素粉剂组（682例）和未预防性万古霉素粉剂组（305例）。收集了人口统计学、合并症、手术类型和SSI发生率的数据。结果：两组间已建立的感染危险特征无显著差异。未接受万古霉素治疗的患者与接受万古霉素治疗的患者相比，SSI无显著差异（0.3% vs 0.7%, P = 0.578）。共6例感染，3/6（50%）发生于非典型脑膜瘤，2/6（33%）发生于神经鞘瘤，1/6（17%）发生于阿米巴脓肿。幕上开颅术（优势比0.95,P = 0.810）和后窝开颅术（优势比1.18,0.545）是最常见的手术，队列间差异无统计学意义。脑膜瘤占病理的最大部分，在两组中均占同等比例。结论：本研究提示，在非恶性颅脑手术中，预防性万古霉素散粉的常规使用可能是不必要的，因为ssi总体发生率较低，组间无显著差异。这些发现提倡采用更有针对性的抗生素预防方法，权衡潜在的益处和已知的风险。
期刊介绍：
Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery.
Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
