2025 Proffered Presentations
S067: EFFICACY OF VANCOMYCIN POWDER PROPHYLAXIS IN 987 CRANIAL SURGERIES FOR NON-MALIGNANT PATHOLOGIES
Wesley Shoap, MD1; Robert Osorio, MD2; Armond Esmaili, MD3; Phil Theodosopulos, MD2; Shawn Hervey-Jumper, MD2; Ezequiel Goldschmidt, MD, PhD2; 1LSU Department of Neurosurgery, New Orleans; 2University of California San Francisco School of Medicine Department of Neurosurgery; 3University of California San Francisco School of Medicine
Background: The use of prophylactic vancomycin powder following cranial procedures remains controversial. In recent years, two large population studies concluded that subgaleal vancomycin powder effectively reduces SSI. However, these studies used a pre/post-intervention design, limiting the interpretation of results.
Methods: A cohort of 1,955 consecutive patients who underwent cranial procedures from July 2021 to May 2024 was studied retrospectively. SSI incidence was compared in one group that received subgaleal vancomycin at closure versus another group that did not. Additional analysis of SSIs included cultured organisms, surgical pathology, smoking status, and reoperations.
Results: There was no significant difference in SSI incidence between patients receiving vs. not receiving vancomycin (9/1,467 (0.6%) vs. 1/492 (0.2%), p=0.467). Supratentorial craniotomy was the most common procedure in both, with a higher predominance in the vancomycin group (57% vs 40%, p<0.001). There were 10 SSIs in total. The most frequently isolated pathogens were skin flora (6/10) followed by gram-negative hospital-acquired infections (3/10) and the most common surgical pathologies were atypical meningiomas (3/10) and glioblastomas (2/10).
Conclusion: In the largest study on this topic to date, we demonstrate that vancomycin powder was not effective in reducing SSI incidence when applied following cranial procedures in this patient cohort. Although our study may lack the power to assess small differences, this result is notable given that (1) the SSI rate in the non-vancomycin group is about 10% of that reported in the same population from the original publications, and (2) the non-vancomycin group had a non-significant lower incidence of SSI. Large-scale randomized prospective studies are needed to better understand its utility.
