Intrawound vancomycin powder for infection prevention in neurosurgical patients: a retrospective cohort study

Surgical site infections (SSIs) are the most frequent healthcare-associated infections in surgical patients and are largely preventable. Neurosurgical procedures are particularly vulnerable due to inherent risk factors. While intrawound vancomycin has been extensively studied in spinal surgery, evidence in cranial procedures remains limited.

We performed a retrospective cohort study of 741 patients undergoing cranial or spinal neurosurgery between November 2014 and February 2024. The primary outcome was the 90-day SSI rate, defined in accordance with CDC surveillance criteria for neurosurgical procedures. Secondary analysis evaluated associations between infection and operative duration, cerebrospinal fluid (CSF) leaks, reintervention, use of surgical drains, emergency surgery, and hospital stay.

After applying exclusion criteria, 548 patients were included: 291 received topical vancomycin powder and 257 served as controls. Infection occurred in 3.1% of the vancomycin group versus 8.6% of controls, representing a 64% reduction in infection risk (RR = 0.36; 95% CI: 0.17-0.77). No adverse events related to vancomycin were observed. CSF leak was the strongest independent predictor of infection, with 26.9% of patients with a leak developing SSI versus 4.6% without (RR = 6.14; 95% CI: 2.8-13.5). Reintervention was also a significant predictor, increasing infection risk by 2.53 times (RR = 2.53; 95% CI: 1.5-4.12). Drain use showed an association in chi-square analysis (RR of 2.17; 95% CI: 1.25-3.75). Operative duration, emergency surgery, and hospital stay were not significantly associated.

Intrawound vancomycin was significantly associated with reduced postoperative SSIs in cranial and spinal neurosurgery.