1386. Effects of Cefazolin vs Vancomycin Neurosurgical Prophylaxis on Postoperative Infections - A Single Institution Analysis
Authors: Anthony Nguyen; William Coggins, BS; Rishabh Jain, BS; Daniel Branch, MD; Randall Allison, MD; Ken Maynard, MD; Brian Oliver, MD; Rishi Lall, MD (Galveston, TX)
Cefazolin and Vancomycin are common choices for neurosurgical antimicrobial prophylaxis. Cefazolin is typically first-line due to its lower toxicity profile and specificity for gram-positives, which skin commensals are, while Vancomycin is often reserved for patients with cephalosporin or penicillin allergies. However, one randomized clinical trial showed Vancomycin to be the superior choice for cerebrospinal fluid (CSF) shunt insertions in one hospital with a high prevalence of methicillin-resistance Staphylococcus aureus (MRSA). We aimed to evaluate the efficacy of Cefazolin and Vancomycin in prevention of SSIs at our own institution.
We retrospectively reviewed charts of patients who underwent a neurosurgical operation performed from 2013-2016 at one particular hospital belonging to our institution. Patients who received neither Cefazolin nor Vancomycin or whose procedures required multidisciplinary surgical teams were excluded. We defined a SSI as a confirmed culture isolated from the wound, implant (if pertinent), or CSF (if pertinent) within a year of surgery. Multivariate logistic regression was performed with consideration of antibiotic, operation performed, wound class, and procedure length.
We reviewed 966 operations; 742 patients received Cefazolin, and 224 received Vancomycin. We identified 34 SSIs, with 21 in the Cefazolin (2.8%) and 13 in the Vancomycin (5.8%) group. Logistic regression did not suggest statistical significance (p=0.31). In the Cefazolin group, 9/21 cultures were positive for Staphylococcus aureus compared to 4/13 of the Vancomycin group. Clean-contaminated wounds were associated with increased infection risk (p=0.04).
There was no significant difference in infection rate between prophylaxis by Cefazolin or Vancomycin at our institution, where S. aureus makes up 36% of isolated organisms from inpatient and intensive care units. However, S. aureus was isolated from patients who received Cefazolin at a higher rate although this was not statistically significant. Institutions should consider their own investigations into SSI rates and choice of prophylaxis.