Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures

Ratilal, Bernardo O; Costa, João; Sampaio, Cristina; Pappamikail, Lia

doi:10.1002/14651858.cd004884.pub3

Cited by 56 publications

(30 citation statements)

References 22 publications

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“…It is used for preventing the appearance of intracranial infections, like meningitis 36 . Many studies have noticed no difference in the prevention of the cerebral complications with or without antibiotics.…”

Section: Treatment Options Of Csf Leaksmentioning

confidence: 99%

Current insights in CSF leaks: a literature review of mechanisms, pathophysiology and treatment options

Patrascu¹,

Manea²,

Sarafoleanu³

2017

Romanian Journal of Rhinology

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A cerebrospinal fluid (CSF) leak occurs when there appears a fistula between the dura and the skull base and it is usually characterized by discharge of cerebrospinal fluid from the nose. Cerebrospinal fluid leaks may have many etiologies, the most common being trauma. The most common site of dural lesion is the cribriform plate of the ethmoid. Diagnosis can be achieved by a multitude of techniques, high-resolution computed tomography being the modality of choice and it may be completed with magnetic resonance imaging or cisternography. Treatment may be either conservative, either surgical, related to the cause, the site and the duration of CSF leak. Conservative treatment usually includes strict bed rest, elevated bed head and no straining, nose blowing or stretching, with resolution of the majority of traumatic CSF leaks in seven days. Surgical treatment consists of a variety of approaches (intracranial/extracranial, open/endoscopic). The future trend is represented by minimally invasive endoscopic approaches, with a success rate of almost 90%; however, open transcranial or extracranial interventions still have indications in the surgical management. CSF leaks must be correctly diagnosed and treated, because the risk of intracranial complications increases 10-fold when the leakage persists.

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Section: Treatment Options Of Csf Leaksmentioning

confidence: 99%

Current insights in CSF leaks: a literature review of mechanisms, pathophysiology and treatment options

Patrascu¹,

Manea²,

Sarafoleanu³

2017

Romanian Journal of Rhinology

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“…[3][4][5]7,9,19,24,25,30 Meta-analyses on this topic were published in 1997 3 and 1998. 30 Brodie 3 showed that the cohort of patients with posttraumatic CSF leakage treated with prophylactic antibiotic therapy had a significantly reduced incidence of meningitis.…”

Section: Factors Predicting Posttraumatic Meningitismentioning

confidence: 99%

“…A major limitation of these meta-analyses was that the findings were primarily based on retrospective and observational studies. Recently, Ratilal et al 25 conducted another meta-analysis in which they reviewed …”

Section: Factors Predicting Posttraumatic Meningitismentioning

confidence: 99%

“…1,2,23,32 Various factors that are associated with the development of posttraumatic meningitis include skull fractures, facial fractures (mainly involving the paranasal sinuses), otological injuries, development of CSF fistulas, and pneumocephalus. 6,8,13,15,16,20,25,31 Typically, fractures of the skull or facial bones may lead to the formation of CSF fistulas, which in turn increase the likelihood of meningitis. 25 There are limited data to support an independent association of meningitis with skull fractures, facial fractures, and subsequent CSF leaks.…”

mentioning

confidence: 99%

“…6,8,13,15,16,20,25,31 Typically, fractures of the skull or facial bones may lead to the formation of CSF fistulas, which in turn increase the likelihood of meningitis. 25 There are limited data to support an independent association of meningitis with skull fractures, facial fractures, and subsequent CSF leaks. 8,13,16,20 Further, it is unclear whether particular subtypes of skull fractures (closed skull base fractures, open skull base, cranial vault fractures) are associated with increased risk of meningitis.…”

mentioning

confidence: 99%

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Is posttraumatic cerebrospinal fluid fistula a predictor of posttraumatic meningitis? A US Nationwide Inpatient Sample database study

Sonig¹,

Thakur²,

Chittiboina³

et al. 2012

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Object Various factors have been reported in literature to be associated with the development of posttraumatic meningitis. There is a paucity of data regarding skull fractures and facial fractures leading to CSF leaks and their association with the development of meningitis. The primary objective of this study was to analyze the US Nationwide Inpatient Sample (NIS) database to elucidate the factors associated with the development of posttraumatic meningitis. A secondary goal was to analyze the overall hospitalization cost related to posttraumatic meningitis and factors associated with that cost. Methods The NIS database was analyzed to identify patients admitted to hospitals with a diagnosis of head injury from 2005 through 2009. This data set was analyzed to assess the relationship of various clinical parameters that may affect the development of posttraumatic meningitis using binary logistic regression models. Additionally, the overall hospitalization cost for the head injury patients who did not undergo any neurosurgical intervention was further categorized into quartile groups, and a regression model was created to analyze various factors responsible for escalating the overall cost of the hospital stay. Results A total of 382,267 inpatient admissions for head injury were analyzed for the 2005–2009 period. Meningitis was reported in 0.2% of these cases (708 cases). Closed skull base fractures, open skull base fractures, cranial vault fractures, and maxillofacial fractures were reported in 20,524 (5.4%), 1089 (0.3%), 5064 (1.3%), and 88,649 (23.2%) patients, respectively. Among these patients with fractures, meningitis was noted in 0.17%, 0.18%, 0.05%, and 0.10% admissions, respectively. Cerebrospinal fluid rhinorrhea was reported in 453 head injury patients (0.1%) and CSF otorrhea in 582 (0.2%). Of the patients reported to have CSF rhinorrhea, 35 (7.7%) developed meningitis, whereas in the cohort with CSF otorrhea, 15 patients (2.6%) developed meningitis. Cerebrospinal fluid rhinorrhea (p < 0.001, OR 22.8, 95% CI 15.6–33.3), CSF otorrhea (p < 0.001, OR 9.2, 95% CI 5.2–16.09), and major neurosurgical procedures (p < 0.001, OR 5.6, 95% CI 4.8–6.5) were independent predictors of meningitis. Further, CSF rhinorrhea (p < 0.001, OR 2.0, 95% CI 1.6–2.7), CSF otorrhea (p < 0.001, OR 2.3, 95% CI 1.9–2.7), and posttraumatic meningitis (p < 0.001, OR 3.1, 95% CI 2.5–3.8) were independent factors responsible for escalating the cost of head injury in cases not requiring any major neurosurgical intervention. Conclusions Cerebrospinal fluid rhinorrhea and CSF otorrhea are independent predictors of posttraumatic meningitis. Furthermore, meningitis and CSF fistulas may independently lead to significantly increased cost of hospitalization in head injury patients not undergoing any major neurosurgical intervention.

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Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures

Ratilal

Costa²,

Pappamikail

et al. 2015

Cochrane Database of Systematic Reviews

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In patients with basilar skull fracture, there is inadequate evidence to recommend for or against antibiotic prophylaxis in the prevention of meningitis, irrespective of cerebrospinal fluid leakage. METHODS DATA SOURCES The authors electronically searched the Cochrane Central Register of Controlled Trials (February 2011), MEDLINE, EMBASE, and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and hand searched abstracts of neurosurgical conference proceedings and reference lists. Experts in the field were contacted to request additional sources. No language or publication restrictions were applied. STUDY SELECTIONStudies were included if they were randomized controlled trials comparing antibiotics versus placebo or no intervention after basilar skull fracture. Primary outcome was the development of meningitis. Similar observational trials were also identified for inclusion in a separate meta-analysis. Three authors independently identified potentially suitable articles from the search strategy, and disagreements were resolved by discussion with the fourth author. DATA EXTRACTION AND SYNTHESISTwo authors independently extracted data with standardized data collection forms and globally

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Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures

Cited by 56 publications

References 22 publications

Current insights in CSF leaks: a literature review of mechanisms, pathophysiology and treatment options

Current insights in CSF leaks: a literature review of mechanisms, pathophysiology and treatment options

Is posttraumatic cerebrospinal fluid fistula a predictor of posttraumatic meningitis? A US Nationwide Inpatient Sample database study

Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures

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