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

Abstract

BackgroundCraniotomies 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. ObjectiveThe 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. MethodsA 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. ResultsTopical 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. ConclusionTopical 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.