Youn Seong Bin, Hwang Gyojun, Kim Hyun-Gon, Kang Jae Seong, Kim Hyung Cheol, Oh Sung Han, Kim Mi-Kyung, Chung Bong Sub, Rhim Jong Kook, Sheen Seung Hun
Department of Neurosurgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea.
Department of Neurosurgery, Myongji St Mary's Hospital, Seoul, Korea.
J Korean Neurosurg Soc. 2023 Sep;66(5):536-542. doi: 10.3340/jkns.2023.0024. Epub 2023 Apr 10.
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.
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.
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.
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.
手术部位感染是颅骨修补术后最有害的并发症。在其他外科领域，已引入伤口内应用万古霉素粉末来预防手术部位感染，并且基于多项研究结果被广泛使用。本研究评估了伤口内应用万古霉素粉末在颅骨修补术中相对于不使用局部抗生素的传统方法的效果。
这项回顾性研究纳入了1998年8月1日至2021年12月31日期间接受颅骨修补术的580例颅骨缺损患者。475例（81.9%；传统组）采用传统方法，105例患者（18.1%；万古霉素粉末组）在硬脑膜和骨瓣上应用万古霉素粉末（1克）。手术部位感染定义为颅骨修补术后发生的切口、器官或间隙感染。采用逻辑回归分析比较传统组和万古霉素粉末组在1年监测期内的手术部位感染情况。逻辑回归中使用惩罚似然估计方法处理零事件。还评估了与局部应用万古霉素相关的所有局部和全身不良事件。
31例患者（5.3%）发生手术部位感染，且均在传统组中观察到。颅骨修补术至手术部位感染检测的中位时间为13天（范围4 - 333天）。葡萄球菌是最常见的病原体，在31例手术部位感染病例中的25例（80.6%）中被鉴定出。万古霉素粉末组的手术部位感染率（0/105，0.0%）显著低于传统组（31/475，6.5%；粗比值比[OR]，0.067；95%置信区间[CI]，0.006 - 0.762；调整后OR，0.068；95% CI，0.006 - 0.731；p = 0.026）。随访期间未观察到与伤口内应用万古霉素粉末相关的不良事件。
伤口内应用万古霉素粉末有效预防了颅骨修补术后的手术部位感染，且无局部或全身不良事件。我们的结果表明，伤口内应用万古霉素粉末对于接受颅骨修补术的患者是一种有效且安全的策略。
