• Pavlos Texakalidis, Victor M Lu, Yagiz Yolcu, Panagiotis Kerezoudis, Mohammed Ali Alvi, Ian F Parney, Jeremy L Fogelson, and Mohamad Bydon.
• Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
• Neurosurgery. 2019 Mar 1; 84 (3): 569-580.

BackgroundSurgical site infections (SSIs) after spine and brain surgery present a major burden to patients and hospitals by increasing morbidity, mortality, and healthcare costs.ObjectiveTo review available literature investigating the role of intrawound powdered vancomycin against SSIs after neurosurgical operations.MethodsAll randomized and observational English language studies of intrawound powdered vancomycin use in spinal and cranial surgery were included and analyzed using random-effects modeling.ResultsIn spine surgery (25 studies with 16 369 patients), patients in the vancomycin group had a significantly lower risk for any SSI (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.30-0.57; P < .001; I2 = 47%). However, when separate analyses were conducted for superficial and deep SSIs, a significant difference was found only for deep (OR: 0.31; 95% CI: 0.22-0.45; P < .001; I2 = 29%). Subgroup analyses for different vancomycin powder dosages (1 g vs 2 g vs composite dose) did not point to any dose-related effect of vancomycin. In cranial surgery (6 studies with 1777 patients), use of vancomycin was associated with a significantly lower risk for SSIs (OR: 0.33; 95% CI: 0.18-0.60; P = .0003; I2 = 45%). In meta-regression analysis, trial-level variability of diabetes had no influence on the association of vancomycin powder use with SSIs.ConclusionUse of vancomycin powder in spinal and cranial surgery might be protective against SSIs, especially against deep SSIs. No dose-related effect of vancomycin powder was identified. However, caution is needed in the clinical interpretation of these results, owing to the observational design of the included studies in this meta-analysis.Copyright © 2018 by the Congress of Neurological Surgeons.

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