Evaluation of prophylactic antibiotics in penetrating brain injuries at an academic level 1 trauma center

Marut, Danielle; Shammassian, Berje; McKenzie, Christina; Adamski, John H.; Traeger, Jessica

doi:10.1016/j.clineuro.2020.105777

Cited by 11 publications

(9 citation statements)

References 10 publications

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“…Fourteen publications were incorporated in our analysis. A majority of the patients in our literature review came from three large case series [ 7 , 14 , 24 ], while the remainder consisted of patients from 11 case reports [ 1 , 5 , 12 , 16 , 18 – 20 , 26 , 29 , 31 , 32 ]. Thirteen studies were excluded most commonly because it was unclear if prophylactic antibiotics were administered ( n = 6), the study was a conference presentation not published in a peer-reviewed journal ( n = 3), the injury was not a penetrating injury involving a breach of the brain parenchyma ( n = 2), the article was in a non-English language ( n = 1), or the authors were unable to access the full text of the article ( n = 1).…”

Section: Resultsmentioning

confidence: 99%

“…The authors reported 12% of their cohort developed an intracranial infection, similar to the findings of our case series. In another study involving pTBI at a large American urban hospital, 24 of 33 patients received prophylactic antibiotics; none of the 33 patients developed a CNS infection [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…In 1998, the International Brain Injury Association, the Brain Injury Association, the American Association of Neurological Surgeons, and the Congress of Neurological Surgeons collaborated on a set of guidelines for treating pTBI and recommended broad-spectrum antibiotics without details regarding which antibiotic to administer, nor the duration of antibiotic used in such cases [ 10 , 34 ]. However, more recent publications noted insufficient evidence concerning the benefit of prophylactic antibiotics in decreasing CNS infections among pTBI patients [ 7 , 14 , 27 ]. Thus, we retrospectively evaluated consecutive patients with pTBI in a single institutional cohort to assess the relationship between empiric antibiotic administration and the development of clinical and microbiological evidence of CNS infection.…”

Section: Introductionmentioning

confidence: 99%

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Antibiotic prophylaxis in penetrating traumatic brain injury: analysis of a single-center series and systematic review of the literature

et al. 2022

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Antibiotic prophylaxis in penetrating traumatic brain injury: analysis of a single-center series and systematic review of the literature

et al. 2022

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“…Recommendations previously reported remain valid, although in some studies, a significant reduction in the duration of antibiotic administration was not associated with an increase in infectious complication incidence. In the study by Marut et al, some patients received only the preoperative dose, and some others were given drugs for no more than 24 h [ 49 ]. Due to the lack of pediatric data, suggestions made for adults can be followed also for children.…”

Section: Resultsmentioning

confidence: 99%

Surgical Antimicrobial Prophylaxis in Neonates and Children Undergoing Neurosurgery: A RAND/UCLA Appropriateness Method Consensus Study

et al. 2022

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Pediatric neurosurgery is a highly specialized branch of surgery in which surgical site infections (SSIs) are potentially serious complications that can also adversely affect a good surgical outcome, compromising functional recovery and, in some cases, even putting the patient’s life at risk. The main aim of this consensus document is to provide clinicians with a series of recommendations on antimicrobial prophylaxis for neonates and children undergoing neurosurgery. The following scenarios were considered: (1) craniotomy or cranial/cranio-facial approach to craniosynostosis; (2) neurosurgery with a trans-nasal-trans-sphenoidal approach; (3) non-penetrating head injuries; (4) penetrating head fracture; (5) spinal surgery (extradural and intradural); (6) shunt surgery or neuroendoscopy; (7) neuroendovascular procedures. Patients undergoing neurosurgery often undergo peri-operative antibiotic prophylaxis, with different schedules, not always supported by scientific evidence. This consensus provides clear and shared indications, based on the most updated literature. This work has been made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies, and represents, in our opinion, the most complete and up-to-date collection of recommendations on the behavior to be held in the peri-operative setting in this type of intervention, in order to guide physicians in the management of the patient, standardize approaches and avoid abuse and misuse of antibiotics.

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“…There is considerable variability in the literature as to the exact type of antibiotics and the length of therapy. Early surgical intervention and debridement <12 hours from presentation decrease the risk of subsequent infection, with watertight dural closure being one of the most significant variables related to minimizing infection [34,39].…”

Section: Infectiousmentioning

confidence: 99%

Penetrating Craniocerebral Injury in Pediatric Patients

Plonsker¹,

Brandel²,

Khan³

et al. 2022

Frontiers in Traumatic Brain Injury

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Penetrating head trauma is rare in the pediatric population, and rarer still in the civilian pediatric population. The high rehabilitation potential of children and the higher likelihood of a low-velocity, survivable injury necessitates careful management to minimize morbidity due to secondary injury from ischemia or infection. Management of penetrating injuries includes patient stabilization, appropriate imaging, and if surgery is needed, entry/exit site debridement with dural closure to prevent cerebrospinal fluid leak. Post-operative care includes infection prevention, intracerebral pressure management, and early identification of vasospasm and pseudoaneurysm formation.

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Evaluation of prophylactic antibiotics in penetrating brain injuries at an academic level 1 trauma center

Cited by 11 publications

References 10 publications

Antibiotic prophylaxis in penetrating traumatic brain injury: analysis of a single-center series and systematic review of the literature

Antibiotic prophylaxis in penetrating traumatic brain injury: analysis of a single-center series and systematic review of the literature

Surgical Antimicrobial Prophylaxis in Neonates and Children Undergoing Neurosurgery: A RAND/UCLA Appropriateness Method Consensus Study

Penetrating Craniocerebral Injury in Pediatric Patients

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