Abstract
Abstract
Purpose
Penetrating traumatic brain injury (pTBI) is an acute medical emergency with a high rate of mortality. Patients with survivable injuries face a risk of infection stemming from foreign body transgression into the central nervous system (CNS). There is controversy regarding the utility of antimicrobial prophylaxis in managing such patients, and if so, which antimicrobial agent(s) to use.
Methods
We reviewed patients with pTBI at our institution and performed a PRISMA systematic review to assess the impact of prophylactic antibiotics on reducing risk of CNS infection.
Results
We identified 21 local patients and 327 cases in the literature. In our local series, 17 local patients received prophylactic antibiotics; four did not. Overall, five of these patients (24%) developed a CNS infection (four and one case of intraparenchymal brain abscess and meningitis, respectively). All four patients who did not receive prophylactic antibiotics developed an infection (three with CNS infections; one superficial wound infection) compared to two of 17 (12%) patients who did receive prophylactic antibiotics. Of the 327 pTBI cases reported in the literature, 216 (66%) received prophylactic antibiotics. Thirty-eight (17%) patients who received antibiotics developed a CNS infection compared to 21 (19%) who did not receive antibiotics (p = 0.76).
Conclusions
Although our review of the literature did not reveal any benefit, our institutional series suggested that patients with pTBI may benefit from prophylactic antibiotics. We propose a short antibiotic course with a regimen specific to cases with and without the presence of organic debris.
Funder
National Institute of Allergy and Infectious Diseases
Publisher
Springer Science and Business Media LLC
Subject
Neurology (clinical),Surgery
Reference35 articles.
1. Ardill W, Gidado S (2003) Penetrating head wound: a remarkable case. Surg Neurol 60(2):120–123 (discussion 123)
2. Bayston R, de Louvois J, Brown EM, Johnston RA, Lees P, Pople IK (2000) Use of antibiotics in penetrating craniocerebral injuries. “Infection in Neurosurgery” Working Party of British Society for Antimicrobial Chemotherapy. Lancet 355(9217):1813–1817
3. Benzel EC, Day WT, Kesterson L, Willis BK, Kessler CW, Modling D, Hadden TA (1991) Civilian craniocerebral gunshot wounds. Neurosurg 29(1):67–71 (discussion 71-72)
4. Frieden T, Houry D, Baldwin G (2015) Report to congress on traumatic brain injury in the United States: epidemiology and rehabilitation. Centers for disease control and prevention, Atlanta, GA (https://www.cdc.gov/traumaticbraininjury/pdf/TBI_Report_to_Congress_Epi_and_Rehab-a.pdf)
5. Gutiérrez-González R, Boto GR, Rivero-Garvía M, Pérez-Zamarrón A, Gómez G (2008) Penetrating brain injury by drill bit. Clin Neurol Neurosurg 110(2):207–210
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