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The Adjunctive Use of Vancomycin Powder Appears Safe and May Reduce the Incidence of Surgical-Site Infections After
Jonathan J Rasouli1, Brian Harris Kopell1
1Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA.
Background:
Postoperative surgical-site infections (SSIs) are a common complication after deep brain stimulation (DBS) surgery, occurring at a quoted rate of approximately 1%-9%. Intraoperative vancomycin powder has demonstrated efficacy in reducing SSIs after cranial and spinal surgery; however, its use during DBS surgery has yet to be established. In this study, we describe the senior author's experience with the use of intraoperative vancomycin powder to prevent SSIs after DBS surgery.
Methods:
We retrospectively examined the incidence of SSI in 297 patients who underwent DBS surgery at the Mount Sinai Health System from September 2012 to December 2015. All patients underwent a uniform perioperative antiseptic protocol, including thorough skin cleansing, intravenous anticephalosporin antibiotics, copious irrigation, and the application of topical vancomycin powder (1 g) before skin closure. Patient information was obtained through a review of electronic medical records. Primary outcome was the incidence of SSI, which was defined per the standards of the Centers for Disease Control and Prevention and confirmed with wound cultures.
Results:
Four patients developed clinical signs and symptoms of SSI (1.3%); all were men with Parkinson disease. The primary organism responsible was Staphylococcus aureus (75%). Two patients presented with neurostimulator infections, and 2 presented with parietal connector-site infections between 2 months and 1 year after initial surgery. No patients in our series developed topical or systemic reactions attributable to the use of vancomycin powder.
Conclusions:
In our experience, vancomycin powder has demonstrated safety and efficacy as an adjunct medication for infection prophylaxis after DBS surgery. Further prospective studies with larger patient cohorts are warranted.
Insights
Topical vancomycin powder effectively reduced surgical-site infections (SSIs) in deep brain stimulation (DBS) surgery. This study found the adjunct medication safe and beneficial for infection prevention in DBS patients.
Area of Science:
- Neurosurgery
- Infectious Disease Prevention
- Pharmacology
Background:
- Postoperative surgical-site infections (SSIs) are a significant complication following deep brain stimulation (DBS) surgery, with reported incidence rates ranging from 1% to 9%.
- Intraoperative vancomycin powder has shown promise in decreasing SSIs in other neurosurgical procedures, but its efficacy in DBS surgery remained unestablished.
- This study details the experience of using intraoperative vancomycin powder for SSI prevention in DBS procedures.
Purpose of the Study:
- To evaluate the safety and efficacy of intraoperative vancomycin powder in preventing SSIs after deep brain stimulation (DBS) surgery.
- To describe the incidence of SSIs in patients undergoing DBS surgery with the application of topical vancomycin powder.
- To assess any adverse reactions associated with the use of vancomycin powder in this context.
Main Methods:
- A retrospective review of 297 patients who underwent DBS surgery between September 2012 and December 2015.
- All patients received a standardized perioperative antiseptic protocol, including intravenous antibiotics and topical vancomycin powder (1 g) before wound closure.
- Surgical-site infection incidence was determined based on Centers for Disease Control and Prevention criteria and confirmed by wound cultures.
Main Results:
- A low incidence of SSI was observed, with 4 out of 297 patients (1.3%) developing infections.
- Staphylococcus aureus was the predominant causative organism (75%), with infections presenting as neurostimulator or connector-site issues between 2 months and 1 year post-surgery.
- No topical or systemic adverse reactions to vancomycin powder were reported in the study cohort.
Conclusions:
- Intraoperative vancomycin powder appears to be a safe and effective adjunctive therapy for SSI prophylaxis in deep brain stimulation surgery.
- The findings support the use of vancomycin powder as part of the infection control strategy for DBS procedures.
- Further research with larger patient groups and prospective designs is recommended to solidify these findings.
