Topical Vancomycin for Prevention of Surgical Site Infection after Craniotomy: Meta-analysis and Systematic Literature Review

Abstract

There is no consensus among neurosurgeons regarding whether the application of topical vancomycin after performing craniotomy has a role in reduction of the risk of surgical site infection and consequently reduction of treatment costs. In order to compare the rate of surgical site infections after craniotomies with and without the use of topical vancomycin, a meta-analysis of the available studies in the literature was carried out. Multiple electronic health databases were searched to identify all the studies published from July 1988 to July 2021 that examined the role of application of topical vancomycin in reduction of the risk of surgical site infection after craniotomy (cSSIs). Effect sizes were expressed in pooled odds ratio (OR) estimates and, because of heterogeneity between studies, random effect of the inverse variance weighted method was used to perform the meta-analysis. Three observational retrospective cohort studies and 1 prospective controlled cohort study were identified, comparing the incidence of surgical site infection after 605 craniotomies in which topical vancomycin was used and after 716 craniotomies in which no such intervention was done. Meta-analysis showed that topical vancomycin decreased incidence of cSSIs (OR 0.13; 95% confidence interval 0.04-0.43). The results of this meta-analysis suggest that the use of topical vancomycin after performing craniotomies is safe and effective in decreasing the incidence of cSSIs, although there is a need to perform randomized controlled trials to strongly support this conclusion.