The Efficacy of Topical Vancomycin in Patients Undergoing Craniotomy to Reduce the Risk of Surgical Site Infection: A Systematic Review and Meta-Analysis.

Abstract

Surgical site infections (SSIs) are the top hospital-acquired infections in postoperative patients undergoing invasive procedures, leading to increased levels of morbidity and mortality. The purpose of this study is to determine the efficacy of topical vancomycin in patients undergoing craniotomy to reduce SSIs. This review was written based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data extraction and full-text review were conducted for the studies that met the inclusion criteria by 6 independent researchers. Articles reported the SSI after craniotomy in patients who were given topical vancomycin were included. Type of surgery, type of topical vancomycin, a dose of topical vancomycin, usage of other antibiotics, organism-caused SSIs, follow-up duration, onset of SSI, depth of SSI, scales used in the study, postoperative stay of SSI patients and patients with no SSI, SSI risk factors, antibiotics side effects, and craniotomy side effects were extracted. Eight studies included a total number of 2510 patients. A total of 998 patients received topical vancomycin, and the control group was 1512. The reported number of SSIs after using topical vancomycin was 12 (1.20%) compared to 81 (5.36%) in the control group. The overall effect size of the study group was risk ratio = 0.22, 95% confidence interval (0.09, 0.53), P = 0.0007, I² = 44%. Topical use of vancomycin in patients undergoing craniotomy procedures led to a significant reduction in infection rate and mortality postcraniotomy in comparison to the control group.