Comparing the Effectiveness of Vancomycin and Cefazolin in Preventing Post craniotomy Surgical Site Infections

Document Type : Original Article(s)

Authors

1 Clinical Assistant of General Surgery, Department of Surgery diseases, School of Medicine, Golestan Hospital, Jundishapur University of Medical Sciences, Ahwaz, Iran

2 Professor, Department of Neurosurgery, School of Medicine, Medical Image and Signal Processing Research Center Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

3 Assistant Professor, Department of Neurosurgery, School of Medicine, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

4 PhD of Neurosurgery, Department of Neurosurgery, School of Medicine Al-Zahra Hospital Isfahan University of Medical Sciences, Isfahan, Iran

5 Clinical Assistant, Department of Neurosurgery, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

6 Clinical Assistant of General Surgery, Department of Surgery Diseases, School of Medicine, Golestan Hospital, Jundishapur University of Medical Sciences, Ahwaz, Iran

Abstract

Background: Surgical Site Infection (SSI) after neurosurgical procedures is one of the most common types of hospital infection, on which different results have been reported regarding the effectiveness of antibiotic use. The present study aimed to investigate the effect of vancomycin and cefazolin in preventing SSI after elective craniotomy.
Methods: This was a double-blind interventional clinical trial conducted among 126 participants (63 in the vancomycin group and 63 in the cefazolin group). The criterion for measuring wound infection was CRP (C-reactive protein) and ESR (Erythrocyte sedimentation rate) on the first and fifth day after surgery, patient's clinical symptoms and wound. Data were analyzed using Chi-square and Independent t-test.
Findings: In total, 9 people in the two groups developed infections after surgery, with 6 people (67%) in the cefazolin group and 3 people (33%) in the vancomycin group. The mean CRP level on the first and fifth days in the cefazolin group was significantly higher than the vancomycin group. There were no significant differences in the study groups in terms of length of hospitalization after infection, interval between surgery and time of infection, ESR at the time of infection, length of operation (hours), type of infection and type of organism.
Conclusion: According to the results, there was no difference between the use of cefazolin and vancomycin in reducing the rate of surgical site infection. The rate of surgical site infection in  this study was higher compared to the results of other studies.

Keywords

Main Subjects

References

  1. Rhoads DD, Wrona A, Foutz A, Blevins J, Glisic K, Person M, et al. Diagnosis of prion diseases by RT-QuIC results in improved surveillance. Neurology 2020; 95(8): e1017-26.
  2. Cheng VCC, Wong SC, Chen JHK, Yip CCY, Chuang VWM, Tsang OTY, et al. Escalating infection control response to the rapidly evolving epidemiology of the coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in Hong Kong. Infect Control Hosp Epidemiol 2020; 41(5): 493-8.
  3. Anderson DJ, Perl T. Basics of surgical site infection: surveillance and prevention. In: Lautenbach E, Malani PN, Woeltje KF, Han JH, Shuman EK, Marschall J, editors. Practical healthcare epidemiology. Cambridge, UK: Cambridge University Press; 2018. p. 147-61.
  4. O'Hara LM, Thom KA, Preas MA. Update to the centers for disease control and prevention and the healthcare infection control practices advisory committee guideline for the prevention of surgical site infection (2017): a summary, review, and strategies for implementation. Am J Infect Control 2018; 46(6): 602-9.
  5. Grasselli G, Scaravilli V, Mangioni D, Scudeller L, Alagna L, Bartoletti M, et al. Hospital-acquired infections in critically ill patients with COVID-19. Chest 2021; 160(2): 454-65.
  6. Moro ML, Sommella L, Gialli M, Tavanti L, Ciolli L, Masini R, et al. Surgical infections surveillance: Results of a sixmonth incidence study in two Italian hospitals. Eur J Epidemiol 1991; 7(6): 641-8.
  7. Winn HR. Youmans and Winn neurological surgery. 7th Philadelphia, PA: Saunders; 2016. p. 2980-7.
  8. Alfawares Y, Folz C, Johnson MD, Prestigiacomo CJ, Ngwenya LB. The history of antibiotic irrigation and prophylaxis in operative neurotrauma: perpetuation of military care in civilian settings. Neurosurg Focus 2022; 53(3): E7.
  9. Shahba M, Daneshvar P, Ghaedamini A, Ghaedamini H. Comparative study of complications after early and late cranioplasty in Kerman Shahid Bahonar Hospital, 2015-2018: A Retrospective Cohort Study [in Persian]. J Mazandaran Univ Med Sci 2022; 32(209): 194-9.
  10. Vippadapu P, Gillani SW, Thomas D, Ahmed F, Gulam SM, Mahmood RK, et al. Choice of antimicrobials in surgical prophylaxis-overuse and surgical site infection outcomes from a tertiary-level care hospital. Front Pharmacol 2022; 13(2): 849044.
  11. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14(1): 73-156.
  12. Shiroky J, Lillie E, Muaddi H, Sevigny M, Choi WJ, Karanicolas P. The impact of negative pressure wound therapy for closed surgical incisions on surgical site infection: a systematic review and meta-analysis. Surgery 2020; 167(6): 1001-9.
  13. Stienen MN, Moser N, Krauss P, Regli L, Sarnthein J. Incidence, depth, and severity of surgical site infections after neurosurgical interventions. Acta Neurochir (Wien) 2019; 161(1): 17-24.
  14. Vogt P, Berdat P, Santoro G, Schmidlin D, Khubulava G, Marchenko S, et al. Significant reduction of sternal wound infection in cardiac surgical patients. Am J Clin Microbiol Antimicrob 2019; 2(2): 1035.
  15. Fang C, Zhu T, Zhang P, Xia L, Sun C. Risk factors of neurosurgical site infection after craniotomy: a systematic review and meta-analysis. Am J Infect Control 2017; 45(11): e123-34.
  16. Schipmann S, Akalin E, Doods J, Ewelt C, Stummer W, Molina ES. When the infection hits the wound: matched case-control study in a neurosurgical patient collective including systematic literature review and risk factors analysis. World Neurosurg 2016; 95: 178-89.
  17. Shi ZH, Xu M, Wang YZ, Luo XY, Chen GQ, Wang X, et al. Post-craniotomy intracranial infection in patients with brain tumors: a retrospective analysis of 5723 consecutive patients. Br J Neurosurg 2017; 31(1): 5-9.
  18. Jiménez-Martínez E, Cuervo G, Hornero A, Ciercoles P, Gabarrós A, Cabellos C, et al. Risk factors for surgical site infection after craniotomy: a prospective cohort study. Antimicrob Resist Infect Control 2019; 8(1): 69.
  19. Mallela AN, Abdullah KG, Brandon C, Richardson AG, Lucas TH. Topical vancomycin reduces surgical-site infections after craniotomy: a prospective, controlled study. Neurosurgery 2018; 83(4): 761-7.
  20. Abode-Iyamah KO, Chiang HY, Winslow N, Park B, Zanaty M, Dlouhy BJ, et al. Risk factors for surgical site infections and assessment of vancomycin powder as a preventive measure in patients undergoing first-time cranioplasty. J Neurosurg 2018; 128(4): 1241-9.
  21. Goorts K, Dizon J, Milanese S. The effectiveness of implementation strategies for promoting evidence informed interventions in allied healthcare: a systematic review. BMC Health Serv Res 2021; 21(4): 241.
  22. Krishnan KG, Müller A, Hong B, Potapov AA, Schackert G, Seifert V, et al. Complex wound-healing problems in neurosurgical patients: risk factors, grading and treatment strategy. Acta Neurochir (Wien) 2012; 154(3): 541-54.
  23. Campioli CC, Challener D, Comba IY, Shah A, Wilson WR, et al. Overview and risk factors for postcraniotomy surgical site infection: A four-year experience. Antimicrob Steward Healthc Epidemiol 2022; 2(1): e14.
  24. Chiang HY, Herwaldt LA, Blevins AE, Cho E, Schweizer ML. Effectiveness of local vancomycin powder to decrease surgical site infections: a meta-analysis. Spine J 2014; 14(3): 397-407.
  25. van Hal M, Lee J, Laudermilch D, Nwasike C, Kang J. Vancomycin powder regimen for prevention of surgical site infection in complex spine surgeries. Clin Spine Surg 2017; 30(8): E1062-5.
  26. Abdullah K, Mallela A, Richardson A, Lucas TH. 155 topical vancomycin reduces surgical-site infections after craniotomy: A prospective, controlled study. Neurosurgery 2017; 64(4): 238-44.
  27. Owens CD, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infect 2008; 70(Suppl 2): 3-10.
  28. Mundhada AS, Tenpe S. A study of organisms causing surgical site infections and their antimicrobial susceptibility in a tertiary-care government hospital. Indian J Pathol Micr 2015; 58(2): 195-200.
  29. Wang G, Zhang S. The risk factors, etiology, and drug resistance of infection after plastic surgery, and corresponding measures. Minerva Chir 2017; 72(5): 499-504.
Journal of Isfahan Medical School
Volume 41, Issue 712
4th Week, May
May and June 2023
Pages 180-187

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History

  • Receive Date: 17 January 2023
  • Revise Date: 02 May 2023
  • Accept Date: 06 May 2023

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