Ravikumar Vinod, Ho Allen L, Pendhakar Arjun V, Sussman Eric S, Kwong-Hon Chow Kevin, Li Gordon
Department of Neurosurgery, Stanford School of Medicine, Stanford, California.
New York Medical College, Valhalla, New York.
Neurosurgery. 2017 May 1;80(5):754-758. doi: 10.1093/neuros/nyw127.
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.
To evaluate the efficacy of intrawound topical vancomycin for prevention of SSIs following open craniotomies.
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.
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.
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.
伤口内应用万古霉素粉末在脊柱融合手术中已得到广泛研究，并被发现可显著降低手术部位感染（SSI）的发生率。尽管其在脊柱手术中取得了成功，但关于颅脑神经外科手术，局部应用万古霉素尚未得到广泛研究。
评估伤口内局部应用万古霉素预防开颅术后SSI的疗效。
在一项关于局部应用万古霉素以降低开颅术后感染率的干预前后研究中，我们回顾性分析了2011年至2015年的350例患者的大样本系列。我们有一个225例患者的干预前对照组和一个接受伤口内局部应用万古霉素的125例患者的干预后组。
我们干预前SSI的发生率为2.2%，在引入局部应用万古霉素后显著降至0%（P < 0.5）。一项临时成本分析表明，开颅手术使用局部应用万古霉素可节省59965美元。
我们的研究发现引入局部应用万古霉素后SSI发生率显著降低。因此，对于所有开颅手术患者，应考虑这种简单的干预措施，作为预防感染和潜在的节省成本的干预措施。
