Efficacy of Vancomycin Powder Prophylaxis in 987 Cranial Surgeries for Nonmalignant Pathology

Area of Science:

• Neurosurgery
• Infectious Disease Prevention
• Surgical Oncology

Background:

• Subgaleal vancomycin powder is increasingly used for preventing surgical site infections (SSIs) in cranial surgery.
• Its widespread application is debated due to studies focusing on high-risk patients and methodological limitations.
• Efficacy in nonmalignant cranial pathologies requires further investigation.

Purpose of the Study:

• To evaluate the effectiveness of prophylactic vancomycin powder in reducing SSIs.
• To assess SSI rates in patients with nonmalignant cranial pathologies receiving vancomycin powder versus those who did not.
• To inform antibiotic prophylaxis strategies in neurosurgery.

Main Methods:

• Retrospective chart review of 987 patients undergoing cranial surgery for nonmalignant pathologies (July 2021-June 2024).
• Comparison of SSI occurrence between patients receiving prophylactic vancomycin powder (682) and those not receiving it (305).
• Analysis of demographic data, comorbidities, procedure types, and SSI rates.

Main Results:

• No significant difference in SSI rates between the vancomycin powder group (0.7%) and the control group (0.3%; P = .578).
• Infections occurred in 6 patients, primarily with atypical meningiomas (50%) and schwannomas (33%).
• Procedure types (supratentorial and posterior fossa craniotomies) and pathology distribution (meningiomas) were similar between groups.

Conclusions:

• Routine prophylactic vancomycin powder may not be necessary for nonmalignant cranial surgeries due to low SSI incidence.
• Findings support a tailored approach to antibiotic prophylaxis, considering individual patient risks and benefits.
• Further research may refine guidelines for antibiotic use in neurosurgery.