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Vancomycin Ointment for MRSA Infection at a Cranioplasty Site

Clinical Pharmacist, Department of Pharmaceutical Services, Hiroshima University Hospital, Hiroshima, Japan

Kaoru Kurisu, MD

Professor, Department of Neurosurgery, Hiroshima University

Kenji Kihira, PhD

Professor and Director, Department of Pharmaceutical Services, Hiroshima University Hospital

Reprints: Hiroaki Ikeda BSPharm, Department of Pharmaceutical Services, Hiroshima University Hospital,1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan, fax 8182-257-5598, ike{at}hiroshima-u.ac.jp

OBJECTIVE: To report a case illustrating therapeutic success with long-term topical application of aseptic vancomycin ointment to treat methicillin-resistant Staphylococcus aureus (MRSA) infection at a cranioplasty site.

CASE SUMMARY: A 63-year-old Japanese woman underwent evacuation of a subdural hematoma complicated by subarachnoid hemorrhage. Subsequent craniotomy for clipping and external decompression of an aneurysm of the neck was followed by cranioplasty using an autologous bone graft. The graft became infected with MRSA, which responded to intravenously infused vancomycin. The graft was then replaced with a ceramic implant. The implant site became reinfected with MRSA. Vancomycin infusion failed on this occasion, despite a favorable in vitro sensitivity test. After obtaining patient consent, investigative treatment was begun using long-term aseptic application of vancomycin 2.5% ointment, resulting in control of the infection and negative cultures.

DISCUSSION: The care of an infection at the site of cranioplasty with a ceramic artificial bone implant is difficult. Our patient's infection resolved with the use of vancomycin ointment. In this case, blood concentrations of vancomycin remained below detectable levels, and no adverse effects resulted from application of vancomycin ointment.

CONCLUSIONS: Topical administration of vancomycin was more effective than systemic administration in the treatment of our patient's MRSA skull implant infection. No adverse effects from topical treatment were encountered over 3 years.

Key Words: methicillin-resistant Staphylococcus aureus, topical therapy, vancomycin

Published Online, December 5, 2003. www.theannals.com, DOI 10.1345/aph.1D178