Top

Acta Neurochirurgica

Published in:

01-03-2022 | Wound Infection | Original Article - Infection

Combined use of vancomycin powder and betadine irrigation lowers the incidence of postcraniotomy wound infection in low-risk cases: a single-center risk-stratified cohort analysis

Authors: Omri Maayan, Christopher Babu, Miguel E. Tusa Lavieri, Jason Chua, Paul J. Christos, Theodore H. Schwartz

Published in: Acta Neurochirurgica | Issue 3/2022

Abstract

Purpose

Postoperative surgical site infections (SSIs) constitute a significant source of morbidity for neurosurgical patients. Protocols that minimize postoperative wound infections are integral to improving outcomes and curtailing expenditures. The present study seeks to identify risk factors for infection and assess the efficacy of prophylactic betadine irrigation and vancomycin powder in addition to standard antibiotic irrigation.

Methods

We reviewed craniotomies performed by THS at Weill Cornell/New York Presbyterian Hospital to treat neuro-oncologic pathology. Patients were divided into three groups: group 1 — antibiotic irrigation, group 2 — antibiotic irrigation and betadine irrigation, group 3 — antibiotic irrigation, betadine irrigation, and vancomycin powder. SSI was confirmed with bacterial culture. Risk factor identification and assessment of treatment paradigms was performed using chi-square tests and univariate logistic regression.

Results

Among 1209 total patients, the 30- and 90-day SSI rates were 1.7% and 3.5%, respectively. Significant predictors of SSI included preoperative use of bevacizumab (OR 40.84; p < 0.0001), foreign body (OR 4.06; p < 0.0001), prior radiation (OR 2.20; p = 0.03), and prior operation/biopsy (OR 1.92; p = 0.04). Risk of infection was 2.1% in low-risk cases and 6.9% in high-risk cases. A significant, incremental decrement in SSIs was identified between the prophylaxis groups, although only among low-risk cases: group 1: 4.53%, group 2: 1.39%, group 3: 0.42% (p = 0.02). Neither vancomycin powder nor betadine significantly reduced the risk of SSI in patients with one or more risk factors.

Conclusion

Vancomycin powder with betadine irrigation decreased SSI rates following neuro-oncologic cranial procedures in patients at low risk of infection (i.e., no preoperative risk factors).

Abdullah KG, Attiah MA, Olsen AS, Richardson A, Lucas TH (2015) Reducing surgical site infections following craniotomy: examination of the use of topical vancomycin. J Neurosurg 123(6):1600–1604. https://doi.org/10.3171/2014.12.JNS142092CrossRefPubMed

Barker FG. Efficacy of prophylactic antibiotics for craniotomy: a meta-analysis. Neurosurgery. 1994;35(3):484-490; discussion 491-492. https://doi.org/10.1227/00006123-199409000-00017

Bokhari R, You E, Zeiler FA et al (2019) Effect of intrawound vancomycin on surgical site infections in nonspinal neurosurgical procedures: a systematic review and meta-analysis. World Neurosurg 123:409-417.e7. https://doi.org/10.1016/j.wneu.2018.10.168CrossRefPubMed

Buchanan IA, Donoho DA, Patel A et al (2018) Predictors of surgical site infection after nonemergent craniotomy: a nationwide readmission database analysis. World neurosurgery 120:e440–e452. https://doi.org/10.1016/j.wneu.2018.08.102CrossRefPubMedPubMedCentral

Bullock R, van Dellen JR, Ketelbey W, Reinach SG (1988) A double-blind placebo-controlled trial of perioperative prophylactic antibiotics for elective neurosurgery. J Neurosurg 69(5):687–691. https://doi.org/10.3171/jns.1988.69.5.0687CrossRefPubMed

Chundamala J, Wright JG (2007) The efficacy and risks of using povidone-iodine irrigation to prevent surgical site infection: an evidence-based review. Can J Surg 50(6):473–481PubMedPubMedCentral

Clark AJ, Butowski NA, Chang SM et al (2011) Impact of bevacizumab chemotherapy on craniotomy wound healing: clinical article. J Neurosurg 114(6):1609–1616. https://doi.org/10.3171/2010.10.JNS101042CrossRefPubMed

Emile SH, Elfallal AH, Abdel-Razik MA, El-Said M, Elshobaky A (2020) A randomized controlled trial on irrigation of open appendectomy wound with gentamicin- saline solution versus saline solution for prevention of surgical site infection. Int J Surg 81:140–146. https://doi.org/10.1016/j.ijsu.2020.07.057CrossRefPubMed

Fang C, Zhu T, Zhang P, Xia L, Sun C (2017) Risk factors of neurosurgical site infection after craniotomy: a systematic review and meta-analysis. Am J Infect Control 45(11):e123–e134. https://doi.org/10.1016/j.ajic.2017.06.009CrossRefPubMed

10.

Ghobrial GM, Cadotte DW, Williams K, Fehlings MG, Harrop JS (2015) Complications from the use of intrawound vancomycin in lumbar spinal surgery: a systematic review. Neurosurg Focus 39(4):E11. https://doi.org/10.3171/2015.7.FOCUS15258CrossRefPubMed

11.

González P, Lobato RD, Boto GR, De la Lama A, Lagares A, Alén JF (2000) Profilaxis antibiótica en neurocirugía. Neurocirugia 11(3):196–202. https://doi.org/10.1016/S1130-1473(00)70960-2CrossRef

12.

Korinek A-M, Baugnon T, Golmard J-L, van Effenterre R, Coriat P, Puybasset L (2008) Risk factors for adult nosocomial meningitis after craniotomy: role of antibiotic prophylaxis. Neurosurgery 62(Suppl 2):532–539. https://doi.org/10.1227/01.neu.0000316256.44349.b1CrossRefPubMed

13.

Korinek A-M, Golmard J-L, Elcheick A et al (2005) Risk factors for neurosurgical site infections after craniotomy: a critical reappraisal of antibiotic prophylaxis on 4,578 patients. Br J Neurosurg 19(2):155–162. https://doi.org/10.1080/02688690500145639CrossRefPubMed

14.

Mallela AN, Abdullah KG, Brandon C, Richardson AG, Lucas TH (2018) Topical vancomycin reduces surgical-site infections after craniotomy: a prospective, controlled study. Neurosurgery 83(4):761–767. https://doi.org/10.1093/neuros/nyx559CrossRefPubMed

15.

McClelland S, Hall WA (2007) Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures. Clin Infect Dis 45(1):55–59. https://doi.org/10.1086/518580CrossRefPubMed

16.

Mueller TC, Loos M, Haller B et al (2015) Intra-operative wound irrigation to reduce surgical site infections after abdominal surgery: a systematic review and meta-analysis. Langenbecks Arch Surg 400(2):167–181. https://doi.org/10.1007/s00423-015-1279-xCrossRefPubMed

17.

Patel KS, Goldenberg B, Schwartz TH (2014) Betadine irrigation and post-craniotomy wound infection. Clin Neurol Neurosurg 118:49–52. https://doi.org/10.1016/j.clineuro.2013.12.015CrossRefPubMedPubMedCentral

18.

Ravikumar V, Ho AL, Pendhakar AV, Sussman ES, Kwong-Hon Chow K, Li G (2017) The use of vancomycin powder for surgical prophylaxis following craniotomy. Neurosurgery 80(5):754–758. https://doi.org/10.1093/neuros/nyw127CrossRefPubMed

19.

Sneh-Arbib O, Shiferstein A, Dagan N et al (2013) Surgical site infections following craniotomy focusing on possible post-operative acquisition of infection: prospective cohort study. Eur J Clin Microbiol Infect Dis 32(12):1511–1516. https://doi.org/10.1007/s10096-013-1904-yCrossRefPubMed

20.

Strobel RM, Leonhardt M, Krochmann A et al (2020) Reduction of postoperative wound infections by antiseptica (RECIPE)?: a randomized controlled trial. Ann Surg 272(1):55–64. https://doi.org/10.1097/SLA.0000000000003645CrossRefPubMed

21.

Strohecker J, Piotrowski WP, Lametschwandtner A. The intra-operative application of povidone-iodine in neurosurgery. J Hosp Infect. 1985;6 Suppl A:123-125. https://doi.org/10.1016/s0195-6701(85)80057-8

22.

Tomov M, Mitsunaga L, Durbin-Johnson B, Nallur D, Roberto R (2015) Reducing surgical site infection in spinal surgery with Betadine irrigation and intra-wound vancomycin powder. Spine (Phila Pa 1976) 40(7):491–499. https://doi.org/10.1097/BRS.0000000000000789CrossRef

23.

Weiser T, Donaldson L, Gawande A (2009) WHO guidelines for safe surgery 2009: safe surgery saves lives. 2009;(WHO/IER/PSP/2008.08-1E):124

24.

Willy C, Scheuermann-Poley C, Stichling M, von Stein T, Kramer A (2017) Importance of wound irrigation solutions and fluids with antiseptic effects in therapy and prophylaxis: update 2017. Unfallchirurg 120(7):549–560. https://doi.org/10.1007/s00113-017-0375-5CrossRefPubMed

Title: Combined use of vancomycin powder and betadine irrigation lowers the incidence of postcraniotomy wound infection in low-risk cases: a single-center risk-stratified cohort analysis
Authors: Omri Maayan
Christopher Babu
Miguel E. Tusa Lavieri
Jason Chua
Paul J. Christos
Theodore H. Schwartz
Publication date: 01-03-2022
Publisher: Springer Vienna
Keywords: Wound Infection
Craniotomy
Antibiotic
Vancomycin
Bevacizumab
Published in: Acta Neurochirurgica / Issue 3/2022
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-021-05075-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Combined use of vancomycin powder and betadine irrigation lowers the incidence of postcraniotomy wound infection in low-risk cases: a single-center risk-stratified cohort analysis

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2022

Long-term outcome after severe traumatic brain injury: a systematic literature review

Maximizing the subtonsillar transcerebellomedullary approach to suprasellar cistern: how I do it

Current decision support tools fail to agree or predict therapeutic decisions in a single cohort of unruptured intracranial aneurysms

Combined use of multimodal techniques for the resection of glioblastoma involving corpus callosum

Hydroxyapatite cement cranioplasty for reconstruction of translabyrinthine approach: aesthetic results, long-term satisfaction, quality of life, and complications

Response to: Some historical remarks on ipsilateral hemiparesis and the absence of decussation of the pyramidal tracts