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.