Impact of 1.5% Aqueous Olanexidine Against Surgical-Site Infections in Neurosurgery.

BACKGROUND AND

OBJECTIVES

Surgical-site infections (SSIs) represent a prevalent postoperative complication. Traditional antiseptics, such as povidone-iodine and chlorhexidine-alcohol, have demonstrated efficacy in diminishing SSIs incidence. A 1.5% aqueous olanexidine, a novel disinfectant, has shown superior bactericidal potency compared with 10% povidone-iodine in gastrointestinal surgery. However, no studies have compared the potential utility of 1.5% aqueous olanexidine with 10% povidone-iodine in neurosurgery. We aimed to evaluate the efficacy of 1.5% aqueous olanexidine and identify risk factors of SSIs in contemporary neurosurgery.

METHODS

We retrospectively analyzed data from patients who underwent neurosurgery between 2016 and 2022. SSIs were categorized as wound infection/epidural abscess and meningitis/brain abscess. All SSIs were defined as wound infection/epidural abscess or meningitis/brain abscess. We examined associations between SSIs and variables, such as age, sex, medical history, operation time and group, cerebrospinal fluid (CSF) leakage, emergent surgery, and use of 1.5% aqueous olanexidine.

RESULTS

We retrospectively analyzed 1393 cases. Wound infection/epidural abscess occurred in 17 cases (1.2%), meningitis/brain abscess in 39 (2.8%), and all SSIs in 53 (3.8%). The incidence of all SSIs was 3.1% with 1.5% aqueous olanexidine and 5.8% with 10% povidone-iodine ( P = .024). Although 1.5% aqueous olanexidine was not independently associated with wound infection/epidural abscess in multivariable analysis, its use was significantly inversely associated with all SSIs (adjusted odds ratio: 0.53; 95% CI: 0.28-0.99). CSF leakage was significantly associated with both wound infection/epidural abscess (17.43; 2.93-103.58) and meningitis/brain abscess (102.83; 18.09-584.56). Shunt, CSF drainage, and cranioplasty were associated with wound infection/epidural abscess (3.47; 1.29-9.37), meningitis/brain abscess (4.79; 2.28-10.08), and all SSIs (8.57; 3.20-22.92). Operation time was significantly associated with all SSIs (3.24; 1.20-8.72).

CONCLUSION

Compared with 10% povidone-iodine, 1.5% aqueous olanexidine may be associated with the prevention of some SSIs in neurosurgical procedures.