Neurosurgery Service, University of Antioquia, Hospital Universitario San Vicente de Paul, Medellin, Colombia.
World Neurosurg. 2013 May-Jun;79(5-6):749-55. doi: 10.1016/j.wneu.2012.06.025. Epub 2012 Jun 19.
To determine risk factors for intracranial infection secondary to penetrating craniocerebral gunshot wounds (PCGWs) in civilian practice, in patients who underwent surgery with removal of bullet fragments, wound debridement, and watertight dural closure.
An observational, analytical, prospective, cohort-type study was conducted with follow-up in a group of patients with PCGWs caused by a low-velocity projectile admitted between January 2000 and November 2010. There were 160 patients, 59 of whom were administered prophylactic antibiotics based on the decision of the treating neurosurgeon. Average follow-up time was 39 months (range, 3-92 months).
Infection occurred in 40 patients (25%); 20 patients received antibiotics (20 of 59 [33.9%]), and 20 patients did not receive antibiotics (20 of 101 [19.8%]). Three variables were independent risk factors for infection: (i) persistence of parenchymal osseous or metallic fragments after surgery (P < 0.0001, relative risk [RR] 7.45); (ii) projectile trajectory through a natural cavity with contaminating flora (P = 0.03, RR 2.84); and (iii) prolonged hospitalization time (P < 0.0001, RR 3.695).
Administration of prophylactic antibiotics was not associated with the incidence of intracranial infection secondary to PCGWs. Projectile trajectory through potentially contaminating cavities, persistence of intraparenchymal osseous or metallic fragments after surgery, and prolonged hospital stay were independent risk factors for intracranial infection.
确定在民用实践中，接受开颅枪伤（PCGW）手术的患者的风险因素，这些手术包括移除弹片、清创和密闭硬脑膜。
本研究是一项观察性、分析性、前瞻性队列研究，对 2000 年 1 月至 2010 年 11 月期间收治的因低能投射物导致的 PCGW 患者进行了随访。共纳入 160 例患者，其中 59 例根据治疗神经外科医生的决定预防性使用抗生素。平均随访时间为 39 个月（范围 3-92 个月）。
40 例（25%）发生感染；20 例接受抗生素治疗（59 例中的 20 例[33.9%]），20 例未接受抗生素治疗（101 例中的 20 例[19.8%]）。3 个变量是感染的独立危险因素：（i）手术后仍有实质骨或金属碎片残留（P < 0.0001，相对风险[RR] 7.45）；（ii）弹丸轨迹穿过带有污染菌群的天然腔隙（P = 0.03，RR 2.84）；（iii）住院时间延长（P < 0.0001，RR 3.695）。
预防性使用抗生素与 PCGW 继发颅内感染的发生率无关。经可能污染的腔隙的弹丸轨迹、手术后实质骨或金属碎片残留、以及住院时间延长是颅内感染的独立危险因素。
