Topical vancomycin reduces surgical site infections in patients subjected to craniotomy for primary brain tumor resection: A comprehensive cancer center experience

• Published in: Clinical neurology and neurosurgery 2022-04, Vol.215, p.107206-107206, Article 107206
• Main Authors: Krafft, Paul R., Agoris, Corin P., Tran, Quan D., Amer, Aboubakr, Alhazaimeh, Mohammad, Dutta, Mudit, Weisman, Sydney, Alikhani, Puya, Tran, Nam D.
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibiotic; Antibiotic Prophylaxis; Antibiotics; Brain cancer; Brain Neoplasms - complications; Brain tumor; Brain tumors; Cancer; Cancer therapies; Cardiovascular disease; Craniotomy; Craniotomy - adverse effects; Demography; Diabetes; Edema; Erythema; Hospitals; Humans; Narcotics; Neurology; Nosocomial infections; Patient satisfaction; Patients; Powders - therapeutic use; Radiation; Retrospective Studies; Risk factors; Staphylococcus infections; Surgical site infection; Surgical site infections; Surgical Wound Infection - drug therapy; Surgical Wound Infection - epidemiology; Surgical Wound Infection - prevention & control; Tumors; Vancomycin; Vancomycin - therapeutic use
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2022.107206

Craniotomies for resection of neoplastic lesions are at increased risk for surgical site infections (SSIs) as compared to non-neoplastic pathologies. SSIs can be detrimental due to delay in pivotal adjuvant therapies. The purpose of this study was to determine the rate of SSI in primary brain tumors, to analyze risk factors, and to evaluate effectiveness of topical vancomycin in reducing SSIs. A retrospective cohort study was conducted at a National Cancer Institutedesignated Comprehensive Cancer Center. Patients with primary brain tumors (n = 799) who were subjected to craniotomy from 2004 to 2014 were included. Patient demographics, tumor characteristics, use of topical vancomycin and clinical outcomes were analyzed. Topical vancomycin was associated with a significantly lower rate of SSI (0.8%) compared to standard care (5%), ( p = 0.00071; OR = 0.15; 95% CI = 0.02 – 0.5). Narcotic use ( p = 0.043; OR = 2.24; 95% CI = 0.96 – 4.81), previous brain radiation ( p = 0.043; OR = 2.08; 95% CI = 1.02 – 4.29), length of hospitalization ( p = 0.01; OR= 1.04; 95% CI = 1.01 – 1.08), and 30 day re-operation ( p = 1.58 ×10 −10; OR = 15.23; 95% CI = 7.06 – 32.71) were associated with increased risk for SSI. Topical vancomycin effectively reduced the rate of SSI in patients subjected to craniotomy for primary brain tumor resection. Furthermore, preoperative narcotic use, previous head/brain radiation, length of hospitalization, and 30-day reoperation were associated with increased risk of SSI. •Craniotomies for resection of primary brain tumors are associated with higher risk of surgical site infections (SSIs) compared to non-neoplastic brain lesions.•SSIs can be detrimental to brain tumor patients due to delay in pivotal adjuvant therapies.•Narcotic use, previous brain radiation, length of hospitalization, and 30-day re-operation are also associated with an increased risk of SSI.•Application of Intraoperative topical vancomycin is associated with a significantly lower rate of SSI compared to standard care.