Local vancomycin powder administration is not the Holy Grail, only on the half way there

Surgical-site infections (SSIs) is a typical sort of hospital acquired infections (HAIs) which leads to a substantial worse prognosis and high national health expenditure. In the latest issue of Neurosurgery, Arka’s prospective observational cohort study with 355 patients (1) showed that vancomycin local use could reduce the incidence of SSIs in patients with craniotomy (0.49% vs. 6%, P=0.002). The study is timely and with great importance due to SSIs after craniotomy may result in significant consequences such as paresis, hydrocephalus and blood stream infections (2). Despite the encouraging results, more concerns with the topical use of vancomycin merit discussion.