Role of topical vancomycin in reduction of postoperative infections in head trauma patients: A developing country experience

Abstract

Background: Postoperative cranial wound infections are a major cause of morbidity, mortality, and financial burden, especially in developing countries. Methods: We prospectively studied 86 patients in a randomized trial; 39 patients received one gram of topical vancomycin powder in the subgaleal space while 47 matched control patients did not. Both groups received identical intraoperative and post-operative care. The primary outcome variable was the postoperative wound infections rate factored by cohort. Secondary outcomes were the timing of infection and the rate of adverse events. Results: Adding topical vancomycin was associated with a significantly lower rate of infection than the standard of care alone (2.6% [1/39] vs. 14.9% [7/47], P =.004). No adverse reactions occurred. Conclusion: Topical vancomycin is safe, and effective in the prevention of surgical site infections following craniotomy. These findings have broad consequences for neurosurgery practice, especially in developing countries with high incidence of head trauma.

A meta‐analysis examined the effect of intrawound vancomycin on surgical site wound infections in non‐spinal neurosurgical operation

“…The chosen studies included 4286 participants who had a non‐spinal neurosurgical operation at the start of the investigations; 1975 of them used intrawound vancomycin, while 2311 were control. Thirteen papers between 2015 and 2022 that matched the inclusion criteria and were included in the meta‐analysis were chosen from a total of 2456 relevant studies that were evaluated 10‐22 …”

“…Thirteen papers between 2015 and 2022 that matched the inclusion criteria and were included in the meta‐analysis were chosen from a total of 2456 relevant studies that were evaluated. 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 …”

“…Thirteen papers between 2015 and 2022 that matched the inclusion criteria and were included in the meta-analysis were chosen from a total of 2456 relevant studies that were evaluated. [10][11][12][13][14][15][16][17][18][19][20][21][22] The intrawound vancomycin had significantly lower surgical site wound infections (OR, 0.28; 95% CI, 0.19-0.40; P < .001) with low heterogeneity (I2 = 32%) compared with control in non-spinal neurosurgical operation as shown in Figures 2 and 3.…”

“…At the start of the investigations, 4286 participants had a non‐spinal neurosurgical operation; 1975 of them used intrawound vancomycin, while 2311 were control 10‐22 . The intrawound vancomycin had significantly lower surgical site wound infections compared with control in non‐spinal neurosurgical operation.…”

“…At the start of the investigations, 4286 participants had a non-spinal neurosurgical operation; 1975 of them used intrawound vancomycin, while 2311 were control. [10][11][12][13][14][15][16][17][18][19][20][21][22] The intrawound vancomycin had significantly lower surgical site wound infections compared with control in non-spinal neurosurgical operation. The low sample size of 2 out of 13 researches in the meta-analysis for care when analysing the results.…”