Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Department of Health Policy and Management, Fay W. Boozman College of Public Health, Little Rock, AR, USA.
Am Surg. 2023 Jul;89(7):3037-3042. doi: 10.1177/00031348221117041. Epub 2022 Aug 18.
Pneumocephalus and cerebrospinal fluid (CSF) leaks are uncommon after trauma, but they expose the sterile CSF to environmental pathogens and create theoretical risk of central nervous system infection (CNSI). Prophylactic antibiotics are commonly given to these patients, but there is a paucity of evidence to guide this practice. We aim to quantify the incidences of these entities and analyze the efficacy of prophylactic antibiotics in preventing CNSIs.
A retrospective cohort study was conducted using our institutional trauma registry. All patients admitted from January 2014 to July 2020 with traumatic pneumocephalus (TP) or basilar skull fracture with CSF leak (BSF-CSF) were included. ICD-9 and ICD-10 codes were used to identify CNSIs. CNSI rates among defined prophylactic antibiotic regimens, no antibiotics, and other antibiotic regimens were evaluated. ANOVA was used to analyze differences between the groups.
365 patients met inclusion criteria: 360 with TP; 5 with BSF-CSF. 1.1% (4/365) of patients developed CNSI, all with isolated traumatic pneumocephalus. 1.4% of patients (1/72) without antibiotics; 1.2% (3/249) receiving IV antibiotics outside of a defined regimen; and 1.1% (1/88) on a designated prophylactic regimen developed CNSIs. ANOVA indicated the incidence of CNSI was not significantly different among patients who received antibiotics or not, regardless of the regimen (p-value 0.958).
TP and BSF-CSF are rare diagnoses among trauma patients. The rate of CNSI is marginal and antibiotics do not appear to confer a protective advantage. A larger trial is needed to elucidate the true effect of antibiotics on preventing CNSIs in patients with these uncommon diagnoses.
创伤后发生气颅和脑脊液（CSF）漏并不常见，但这会使无菌的 CSF 暴露于环境病原体中，并产生中枢神经系统感染（CNSI）的理论风险。通常会给这些患者预防性使用抗生素，但指导这种做法的证据很少。我们旨在量化这些疾病的发生率，并分析预防性抗生素在预防 CNSI 中的疗效。
我们使用机构创伤登记处进行了回顾性队列研究。纳入 2014 年 1 月至 2020 年 7 月期间因创伤性气颅（TP）或颅底骨折伴 CSF 漏（BSF-CSF）入院的所有患者。使用 ICD-9 和 ICD-10 编码来识别 CNSI。评估了定义的预防性抗生素方案、无抗生素和其他抗生素方案中 CNSI 的发生率。使用方差分析（ANOVA）分析组间差异。
365 名患者符合纳入标准：360 名患者患有 TP；5 名患者患有 BSF-CSF。有 1.1%（4/365）的患者发生 CNSI，均为单纯性创伤性气颅。未使用抗生素的患者中有 1.4%（1/72）；在规定方案之外接受 IV 抗生素治疗的患者中有 1.2%（3/249）；接受指定预防性方案的患者中有 1.1%（1/88）发生 CNSI。ANOVA 表明，无论使用何种方案，接受或不接受抗生素的患者 CNSI 的发生率均无显著差异（p 值 0.958）。
TP 和 BSF-CSF 在创伤患者中是罕见的诊断。CNSI 的发生率较低，抗生素似乎没有提供保护优势。需要更大的试验来阐明抗生素对预防这些罕见诊断患者 CNSI 的真实影响。
