Effect of Intrawound Vancomycin on Surgical Site Infections in Nonspinal Neurosurgical Procedures: A Systematic Review and Meta-Analysis.

Anti-Bacterial Agents / therapeutic use Databases, Bibliographic / statistics & numerical data Humans Neurosurgical Procedures / adverse effects Surgical Wound Infection / drug therapy Vancomycin / therapeutic use
Infection prevention Intrawound vancomycin Surgical site infection Topical vancomycin Vancomycin powder

Journal

World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275

Informations de publication

Date de publication:
Mar 2019
Historique:
received: 03 07 2018
revised: 24 10 2018
accepted: 25 10 2018
pubmed: 6 11 2018
medline: 2 4 2019
entrez: 5 11 2018
Statut: ppublish

Résumé

Applying vancomycin into the surgical site has been well-described in spinal neurosurgery, with extensive institutional experience and systematic reviews describing its effectiveness in reducing surgical site infections (SSIs). Its use in nonspinal neurosurgical procedures is a logical extension of those findings; however, recent studies have described varying degrees of success. We have summarized the effect of local vancomycin application on SSIs in nonspinal neurosurgical procedures and describe the quality of the supporting evidence. MEDLINE, Embase, and Google Scholar were searched through June 2018. Information on study design, demographic data, exposure, and outcomes was extracted. The estimates were combined using random-effects models. Our search retrieved 9 studies for quantitative analysis. They assessed vancomycin use in craniotomy, cranioplasty, deep brain stimulator-related procedures, and ventriculoperitoneal shunt surgery. Most of the studies had serious methodological shortcomings that introduced confounding. We found an overall beneficial effect on SSI incidence (odds ratio, 0.25; 95% confidence interval, 0.12-0.52), which was seen across all subspecialties, except for cranioplasty. The use of vancomycin did not result in the emergence of resistant infections or in a significant increase in the proportion of infections caused by gram-negative organisms. Vancomycin use in nonspinal neurosurgery is not supported by high-quality evidence, limiting the strength of the conclusions that can be drawn on the topic. Nonetheless, we found an overall favorable effect on SSIs (except in the context of cranioplasty), which should be reproduced in a randomized controlled fashion.

Sections du résumé

BACKGROUND BACKGROUND
Applying vancomycin into the surgical site has been well-described in spinal neurosurgery, with extensive institutional experience and systematic reviews describing its effectiveness in reducing surgical site infections (SSIs). Its use in nonspinal neurosurgical procedures is a logical extension of those findings; however, recent studies have described varying degrees of success. We have summarized the effect of local vancomycin application on SSIs in nonspinal neurosurgical procedures and describe the quality of the supporting evidence.
METHODS METHODS
MEDLINE, Embase, and Google Scholar were searched through June 2018. Information on study design, demographic data, exposure, and outcomes was extracted. The estimates were combined using random-effects models.
RESULTS RESULTS
Our search retrieved 9 studies for quantitative analysis. They assessed vancomycin use in craniotomy, cranioplasty, deep brain stimulator-related procedures, and ventriculoperitoneal shunt surgery. Most of the studies had serious methodological shortcomings that introduced confounding. We found an overall beneficial effect on SSI incidence (odds ratio, 0.25; 95% confidence interval, 0.12-0.52), which was seen across all subspecialties, except for cranioplasty. The use of vancomycin did not result in the emergence of resistant infections or in a significant increase in the proportion of infections caused by gram-negative organisms.
CONCLUSIONS CONCLUSIONS
Vancomycin use in nonspinal neurosurgery is not supported by high-quality evidence, limiting the strength of the conclusions that can be drawn on the topic. Nonetheless, we found an overall favorable effect on SSIs (except in the context of cranioplasty), which should be reproduced in a randomized controlled fashion.

Identifiants

DOI: 10.1016/j.wneu.2018.10.168 PMID: 30391768
pubmed: 30391768
pii: S1878-8750(18)32466-5
doi: 10.1016/j.wneu.2018.10.168
pii:
doi:

Substances chimiques

Anti-Bacterial Agents 0
Vancomycin 6Q205EH1VU

Types de publication

Journal Article Meta-Analysis Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

409-417.e7

Informations de copyright

Copyright © 2018 Elsevier Inc. All rights reserved.

Auteurs

Rakan Bokhari (R)

Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Neurology and Neurosurgery, McGill University-Montreal Neurological Hospital and Institute, Montreal, Quebec, Canada; Orthopaedic Research Laboratory, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Quebec, Canada. Electronic address: rfbokhari@kau.edu.sa.

Eunice You (E)

McGill University, Montreal, Quebec, Canada.

Frederick A Zeiler (FA)

Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Clinician Investigator Program, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.

Mohamad Bakhaidar (M)

Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Neurology and Neurosurgery, McGill University-Montreal Neurological Hospital and Institute, Montreal, Quebec, Canada.

Khalid Bajunaid (K)

Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia.

Oliver Lasry (O)

Department of Neurology and Neurosurgery, McGill University-Montreal Neurological Hospital and Institute, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.

Saleh Baeesa (S)

Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.

Judith Marcoux (J)

Department of Neurology and Neurosurgery, McGill University-Montreal Neurological Hospital and Institute, Montreal, Quebec, Canada.

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Classifications MeSH

questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antibactériens › Effect of Intrawound Vancomycin on Surgical...
questionsmedicales.fr › Sciences de l'information › Mémorisation et recherche des informations › Bases de données comme sujet › Bases de données bibliographiques › Effect of Intrawound Vancomycin on Surgical...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Effect of Intrawound Vancomycin on Surgical...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de neurochirurgie › Effect of Intrawound Vancomycin on Surgical...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Infection de plaie opératoire › Effect of Intrawound Vancomycin on Surgical...
questionsmedicales.fr › Acides aminés, peptides et protéines › Peptides › Glycopeptides › Vancomycine › Effect of Intrawound Vancomycin on Surgical...