Could more be better? Use of dual antibiotic prophylaxis with vancomycin and cefazolin associated with lower rates of SSI following craniotomy—one center’s experience.

Reviewed by Cindy Noyes, MD; University of Vermont Medical Center, Burlington, VT

Campioli et al describe a cohort of patients requiring craniotomy from January 1, 2017 through December 31, 2020 for varied indications.  Out of 5328 cases, 59 or 1.1% developed a surgical site infection (SSI). Compared to those without infection, those with SSI underwent a higher proportion of emergency procedures and experienced a higher frequency of contaminated wound class. Most common pathogens isolated included Staphylococcus aureus, coagulase negative staphylococci (CoNS) and Cutibacterium acnes. Interestingly, dual antibiotic prophylaxis with both vancomycin and cefazolin was more prevalent in the group without infection, and associated with a decreased OR of 0.17 for SSI (95% CI 0.005-0.42, p<0.001). The authors suggest protective effect could be related to vancomycin use given significant oxacillin resistance in infecting isolates (oxacillin susceptibility 77% in Staphylococcus aureus, 40% in CoNS). Although a single center experience, this study highlights the need for heightened awareness of local resistance patterns when devising prophylaxis regimens and ultimately, prospective investigation of ideal prophylaxis to prevent postcraniotomy SSI. 

Reference: Corsini Campioli C, et al (2022).  Overview and risk factors for postcraniotomy surgical site infection: A four-year experience. Antimicrobial Stewardship and Healthcare Epidemiology,

We use cookies to help improve your experience