Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Intrawound Vancomycin Powder Application for Preventing Surgical Site Infection Following Cranioplasty

  • Seong Bin Youn (Department of Neurosurgery, Bundang Jesaeng General Hospital, Daejin Medical Center) ;
  • Gyojun Hwang (Department of Neurosurgery, Bundang Jesaeng General Hospital, Daejin Medical Center) ;
  • Hyun-Gon Kim (Department of Neurosurgery, Bundang Jesaeng General Hospital, Daejin Medical Center) ;
  • Jae Seong Kang (Department of Neurosurgery, Bundang Jesaeng General Hospital, Daejin Medical Center) ;
  • Hyung Cheol Kim (Department of Neurosurgery, Bundang Jesaeng General Hospital, Daejin Medical Center) ;
  • Sung Han Oh (Department of Neurosurgery, Bundang Jesaeng General Hospital, Daejin Medical Center) ;
  • Mi-Kyung Kim (Department of Neurosurgery, Myongji St Mary's Hospital) ;
  • Bong Sub Chung (Department of Neurosurgery, Anyang Sam Hospital) ;
  • Jong Kook Rhim (Department of Neurosurgery, Jeju National University Hospital) ;
  • Seung Hun Sheen (Department of Neurosurgery, Bundang CHA Medical Center, CHA University)
  • Received : 2023.01.30
  • Accepted : 2023.04.04
  • Published : 2023.09.01
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Abstract

Objective : Surgical site infection is the most detrimental complication following cranioplasty. In other surgical fields, intrawound vancomycin powder application has been introduced to prevent surgical site infection and is widely used based on results in multiple studies. This study evaluated the effect of intrawound vancomycin powder in cranioplasty compared with the conventional method without topical antibiotics. Methods : This retrospective study included 580 patients with skull defects who underwent cranioplasty between August 1, 1998 and December 31, 2021. The conventional method was used in 475 (81.9%; conventional group) and vancomycin powder (1 g) was applied on the dura mater and bone flap in 105 patients (18.1%; vancomycin powder group). Surgical site infection was defined as infection of the incision, organ, or space that occurred after cranioplasty. Surgical site infection within 1-year surveillance period was compared between the conventional and vancomycin powder groups with logistic regression analysis. Penalized likelihood estimation method was used in logistic regression to deal with zero events. All local and systemic adverse events associated with topical vancomycin application were also evaluated. Results : Surgical site infection occurred in 31 patients (5.3%) and all were observed in the conventional group. The median time between cranioplasty and detection of surgical site infection was 13 days (range, 4-333). Staphylococci were the most common organisms and identified in 25 (80.6%) of 31 cases with surgical site infections. The surgical site infection rate in the vancomycin powder group (0/105, 0.0%) was significantly lower than that in the conventional group (31/475, 6.5%; crude odds ratio [OR], 0.067; 95% confidence interval [CI], 0.006-0.762; adjusted OR, 0.068; 95% CI, 0.006-0.731; p=0.026). No adverse events associated with intrawound vancomycin powder were observed during the follow-up. Conclusion : Intrawound vancomycin powder effectively prevented surgical site infections following cranioplasty without local or systemic adverse events. Our results suggest that intrawound vancomycin powder is an effective and safe strategy for patients undergoing cranioplasty.

Keywords

References

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