Infections in traumatic brain injury patients

Abstract

Traumatic brain injury (TBI) victims are considered to be at high risk for infection. The purpose of this cohort study was to delineate the rates, types and risk factors for infection in TBI patients. Retrospective surveillance of infections was conducted for all TBI patients, aged ≥18 years, cared for at the Department of Neurosurgery of the University Hospital of Heraklion, Greece, between 1999 and 2005. A total of 760 patients (75% men) with a median age of 41 years were included. Most (59%) were injured in a motor vehicle accident. One third of them underwent a surgical procedure. Two hundred and fourteen infections were observed. The majority were infections of the lower respiratory tract (47%), followed by surgical site infections (SSI) (17%). Multivariate analysis showed that SSI development was independently associated with the performance of ≥2 surgical procedures (OR 16.7), presence of concomitant infections, namely VAP (OR 5.7) and UTI (OR 8.8), insertion of lumbar (OR 34.5) and ventricular drains (OR 4.0), and cerebrospinal fluid (CSF) leak (OR 3.8). Development of meningitis was associated with prolonged hospitalization (OR 1.02), especially >7 days ICU stay (OR 25.5), and insertion of lumbar (OR 297) and ventricular drains (OR 9.1). There was a notable predominance of Acinetobacter spp. as a VAP pathogen; gram-positive organisms remained the most prevalent in SSI cases. Respiratory tract infections were the most common among TBI patients. Device-related communication of the CSF with the environment and prolonged hospitalization, especially in the ICU setting, were independent risk factors for SSIs and meningitis cases.

Infections in patients undergoing craniotomy: risk factors associated with post-craniotomy meningitis

“…Scheduling the procedure as an emergency or not an emergency was not a risk factor for PCM, a finding that we had described before. 15 Entering a sinus was not a risk factor in this prospective study, in contrast to our retrospective report, 15 and the reports of others.…”

“…2,11,12,23,26 In our series, the presence of CSF leak was associated with a 48-fold increase in the risk of meningitis, and this was statistically significant. This is much higher than the risk we had identified in a previous retrospective study, 15 in which the CSF leak increased the risk of meningitis by a factor of 1.7 but was not a statistically significant risk factor. Surgeons should be very vigilant in correcting a CSF leak.…”

“…15,19,20,24,28 Ventriculitis in association with ventricular drain placement was a frequent problem and was observed in 11% of general neurosurgical patients in the series by Mayhall et al 20 There is little agreement among various series regarding the relation between duration of drainage and infection incidence; in one report, no relation was observed. 19 Lozier et al 17 have commented on the controversy regarding the significance of the duration of EVD use with respect to the development of infections.…”

“…Leaving an uninfected drain in place may be the best policy. 15 In our institution, dressings were changed daily, the catheters were replaced at the first sign of infection or malfunction. Antibiotic-coated catheters were not routinely placed; we used them after the first catheter change for any reason or in patients who already had signs of infection and needed an EVD placed because of intraventricular hemorrhage or obstructive hydrocephalus.…”

“…This has not been described before in studies regarding PCM and in most studies regarding postoperative wound infections in general neurosurgical patients. 4,5,[12][13][14][15]23,26,28,33 The effect of steroids on patients undergoing neurosurgical procedures has been variably reported. 21 In certain studies, the steroid effect has not been specifically investigated.…”