Topical vancomycin surgical prophylaxis in pediatric open craniotomies: an institutional experience

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Topical antimicrobial compounds are safe and can reduce cost and complications associated with surgical site infections (SSIs). Topical vancomycin has been an effective tool for reducing SSIs following routine neurosurgical procedures in the spine and following adult craniotomies. However, widespread adoption within the pediatric neurosurgical community has not yet occurred, and there are no studies to report on the safety and efficacy of this intervention. The authors present the first institution-wide study of topical vancomycin following open craniotomy in the pediatric population.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>In this retrospective study the authors reviewed all open craniotomies performed over a period from 05/2014 to 12/2016 for topical vancomycin use, SSIs, and clinical variables associated with SSI. Topical vancomycin was utilized as an infection prophylaxis and was applied as a liquid solution following replacement of a bone flap or after dural closure when no bone flap was reapplied.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Overall, 466 consecutive open craniotomies were completed between 05/2014 and 12/2016, of which 43% utilized topical vancomycin. There was a 1.5% SSI rate in the nontopical cohort versus 0% in the topical vancomycin cohort (p = 0.045). The number needed to treat was 66. There were no significant differences in risk factors for SSI between cohorts. There were no complications associated with topical vancomycin use.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Routine topical vancomycin administration during closure of open craniotomies can be a safe and effective tool for reducing SSIs in the pediatric neurosurgical population.</jats:p></jats:sec>

Robotic guidance platform for laser interstitial thermal ablation and stereotactic needle biopsies: a single center experience

“…Finally, the high initial cost of ROSA platform could be overwhelmed with its multiple applications not only limited to stereotactic biopsies [ 4 , 15 , 36 ]. Future studies should focus in the statistical analysis to find differences among frameless robotic and frameless non-robotic procedures to justify the cost-effectiveness of the device to be used in countries with limited resources.…”

“…The recently FDA-approved Robotic Surgical Assistant (ROSA ONE Brain; MedTech, France) is an emerging robotic technology used in neurological surgery to assist in planning and performing minimally invasive procedures. While use of ROSA in the epilepsy field has been described extensively for stereo-electroencephalography (SEEG) placement [ 3 , 4 ] and laser ablation of epileptogenic foci [ 5 , 6 ] data regarding its utility in neurosurgical oncology is limited.…”

Are preoperative chlorhexidine gluconate showers associated with a reduction in surgical site infection following craniotomy? A retrospective cohort analysis of 3126 surgical procedures

“…Third, stringent criteria were used to determine each SSI (i.e., SSI definitions of the National Healthcare Safety Network), possibly leading to a lower rate of infection of 0.6% compared with reports of 1.6%-9% in the literature. 23,41,42 Our SSI rate may not account for patients whose admissions for SSI were outside the University of California, San Francisco system. Indeed, these may not have been captured by the data provided to us by the National Healthcare Safety Network.…”

Neurosurgical Infections

“…63 In a recent prospective study of 101 cranioplasty cases, there was no difference in the incidence of postcranioplasty surgical site infection using bone flaps stored either by cryopreservation or in subcutaneous pockets, 64 and older studies support this finding. 65 More recently, there are several reports suggesting that topical vancomycin, applied as a liquid solution intrawound following open craniotomy, can reduce infection rates in both pediatric 66 and adult patients. 67 One study found a reduction from 6 to 0.49% in a prospectively followed cohort of 355 patients.…”