Antibiotic Prophylaxis in Penetrating Brain Injury: A Systematic Review of the Literature. (16th November 2020)

• Record Type: Journal Article
• Authors: Sunshine, Kerrin; Penuela, Maria; Defta, Dana; Herring, Eric; Sajatovic, Martha; Traeger, Jessica; Shammassian, Berje H
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_429
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Civilian penetrating brain injury is a common pathology at trauma centers across the United States. The development of infection, including superficial wound infection, meningitis, or intracranial abscess can lead to significant morbidity in this patient population. Rates of infection vary among studies and there are few guidelines on interventions to prevent infections. METHODS: A systematic review of the literature was performed to identify studies regarding antibiotic use in civilian penetrating brain injury from 2000–2020. All types of studies were included. Abstracts were screened for inclusion based on English language, penetrating trauma involving dural puncture, age greater than 15 years, and patients within high income countries. Data was extracted to identify demographic information, type of penetrating object, type of intervention performed, prophylactic antibiotic regimen, rate and type of infection, and adverse events associated with antibiotics. RESULTS: Forty full text articles were identified, resulting in a study population of 903 patients. Prophylactic antibiotics were administered in 577 patients (64.0%). Of the patients given prophylactic antibiotics, 8.32% developed infection [95% CI 6.07-10.57%] compared to 6.75% [95% CI 4.03-9.47%] in patients without prophylaxis. Of the patients with a documented antibiotic regimen (n = 71), 39.4% were given prophylaxis consisting of a single class of antibiotic. A variety of antibiotic classes were given for prophylaxis. Similarly, the duration of antibiotic prophylaxis varied throughout studies. CONCLUSION: Over the past 20 years, data has been published for many civilian patients with penetrating brain injury. In high income countries, antibiotic prophylaxis for these patients is not universal, with only a slight majority of patients receiving antibiotics with the intention of preventing infection. Further, antibiotic regimens vary widely between cases. Interestingly, our results show similar infection rates amongst patients regardless of the use of prophylaxis.