Impact of Powdered Vancomycin on Preventing Surgical Site Infections in Neurosurgery: A Systematic Review and Meta-analysis

Pavlos Texakalidis, Victor M. Lu, Yagiz Yolcu, Panagiotis Kerezoudis, Mohammed Ali Alvi, Ian F. Parney, Jeremy L. Fogelson, Mohamad Bydon

Research output: Contribution to journalReview articlepeer-review

12 Scopus citations


BACKGROUND: Surgical site infections (SSIs) after spine and brain surgery present amajor burden to patients and hospitals by increasing morbidity, mortality, and healthcare costs. OBJECTIVE: To review available literature investigating the role of intrawound powdered vancomycin against SSIs after neurosurgical operations. METHODS: All randomized and observational English language studies of intrawound powdered vancomycin use in spinal and cranial surgerywere included and analyzed using random-effects modeling. RESULTS: In spine surgery (25 studies with 16 369 patients), patients in the vancomycin group had a significantly lower risk for any SSI (odds ratio [OR]: 0.41;95%confidence interval [CI]: 0.30-0.57; P < .001; I2 = 47%). However, when separate analyses were conducted for superficial and deep SSIs, a significant difference was found only for deep (OR: 0.31; 95% CI: 0.22-0.45; P<.001; I2 =29%). Subgroup analyses for different vancomycin powder dosages (1 g vs 2 g vs composite dose) did not point to any dose-related effect of vancomycin. In cranial surgery (6 studies with 1777 patients), use of vancomycin was associated with a significantly lower risk for SSIs (OR: 0.33; 95% CI: 0.18-0.60; P = .0003; I2 = 45%). In metaregression analysis, trial-level variability of diabetes had no influence on the association of vancomycin powder use with SSIs. CONCLUSION: Use of vancomycin powder in spinal and cranial surgery might be protective against SSIs, especially against deep SSIs. No dose-related effect of vancomycin powder was identified. However, caution is needed in the clinical interpretation of these results, owing to the observational design of the included studies in this meta-analysis.

Original languageEnglish (US)
Pages (from-to)569-580
Number of pages12
JournalClinical neurosurgery
Issue number3
StatePublished - Mar 1 2019


  • Cranial
  • Infection
  • Powder
  • Spine
  • Surgical site
  • Vancomycin

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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