Department of Pharmacy, Cleveland Clinic Avon Hospital, Avon, OH, USA.
Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Clin Neurol Neurosurg. 2020 Jun;193:105777. doi: 10.1016/j.clineuro.2020.105777. Epub 2020 Mar 4.
Infections from penetrating brain injuries (PBI) lead to higher morbidity and mortality rates. The results of this research will be evaluated to develop institutional guideline for antibiotic prophylaxis in this patient population. The objective was to characterize the prophylactic antibiotic usage for patients presenting with PBI.
This retrospective chart review included patients with a PBI identified through the institution's trauma center registry between December 2015 and July 2018. The primary outcome was the proportion of patients that received prophylactic antibiotics. Secondary outcomes included antibiotic administration timing, selection and duration of antibiotic regimens, infection rates and patient outcomes.
The study population included 33 patients, with 82 % males and an average age of 32 years. The most common mechanism of injury was a gunshot wound (94 %). Of the 33 patients, 24 (73 %) received at least one dose of prophylactic antibiotics. The median time to antibiotic administration was 52.8 min (IQR, 18-120), while the median duration of prophylaxis was 24 h (IQR, 7-84). The most common antibiotic regimen was a single cefazolin dose, with the next most common regimen included scheduled ceftriaxone and metronidazole. Overall, there were no documented central nervous system or skin and soft tissue infections during the initial admission, while 4 patients (12 %) were treated for pneumonia. Survivors (67 %) had a median hospital length of stay of 5.8 days.
The median duration of prophylaxis was shorter than the current data suggesting antibiotics for 5 days; however, there were no documented central nervous system infections, which is less than previously reported in the literature.
穿透性脑损伤（PBI）引起的感染会导致更高的发病率和死亡率。本研究旨在为该患者人群制定抗生素预防方案，对其结果进行评估。本研究旨在确定 PBI 患者预防性使用抗生素的情况。
本回顾性图表研究纳入了 2015 年 12 月至 2018 年 7 月期间通过该机构创伤中心登记处确定的 PBI 患者。主要结果是接受预防性抗生素治疗的患者比例。次要结果包括抗生素给药时机、抗生素方案的选择和持续时间、感染率和患者结局。
研究人群包括 33 例患者，其中 82%为男性，平均年龄为 32 岁。最常见的损伤机制是枪伤（94%）。33 例患者中，24 例（73%）至少接受了一剂预防性抗生素。抗生素给药的中位时间为 52.8 分钟（IQR，18-120），而预防的中位持续时间为 24 小时（IQR，7-84）。最常见的抗生素方案是单次头孢唑啉剂量，其次常见的方案包括头孢曲松和甲硝唑。总的来说，初次入院期间无中枢神经系统或皮肤和软组织感染的记录，而 4 例（12%）患者接受了肺炎治疗。幸存者（67%）的中位住院时间为 5.8 天。
预防的中位持续时间短于目前建议的 5 天，但无中枢神经系统感染的记录，这少于文献中的先前报道。
