Abstract：
Penetrating traumatic brain injury (pTBI) is an acute medical emergency with a high rate of mortality. Patients with survivable injuries face a risk of infection stemming from foreign body transgression into the central nervous system (CNS). There is controversy regarding the utility of antimicrobial prophylaxis in managing such patients, and if so, which antimicrobial agent(s) to use.
We reviewed patients with pTBI at our institution and performed a PRISMA systematic review to assess the impact of prophylactic antibiotics on reducing risk of CNS infection.
We identified 21 local patients and 327 cases in the literature. In our local series, 17 local patients received prophylactic antibiotics; four did not. Overall, five of these patients (24%) developed a CNS infection (four and one case of intraparenchymal brain abscess and meningitis, respectively). All four patients who did not receive prophylactic antibiotics developed an infection (three with CNS infections; one superficial wound infection) compared to two of 17 (12%) patients who did receive prophylactic antibiotics. Of the 327 pTBI cases reported in the literature, 216 (66%) received prophylactic antibiotics. Thirty-eight (17%) patients who received antibiotics developed a CNS infection compared to 21 (19%) who did not receive antibiotics (p = 0.76).
Although our review of the literature did not reveal any benefit, our institutional series suggested that patients with pTBI may benefit from prophylactic antibiotics. We propose a short antibiotic course with a regimen specific to cases with and without the presence of organic debris.
We reviewed patients with pTBI at our institution and performed a PRISMA systematic review to assess the impact of prophylactic antibiotics on reducing risk of CNS infection.
We identified 21 local patients and 327 cases in the literature. In our local series, 17 local patients received prophylactic antibiotics; four did not. Overall, five of these patients (24%) developed a CNS infection (four and one case of intraparenchymal brain abscess and meningitis, respectively). All four patients who did not receive prophylactic antibiotics developed an infection (three with CNS infections; one superficial wound infection) compared to two of 17 (12%) patients who did receive prophylactic antibiotics. Of the 327 pTBI cases reported in the literature, 216 (66%) received prophylactic antibiotics. Thirty-eight (17%) patients who received antibiotics developed a CNS infection compared to 21 (19%) who did not receive antibiotics (p = 0.76).
Although our review of the literature did not reveal any benefit, our institutional series suggested that patients with pTBI may benefit from prophylactic antibiotics. We propose a short antibiotic course with a regimen specific to cases with and without the presence of organic debris.
摘要：
目的：穿透性颅脑损伤（pTBI）是一种急性医疗紧急情况，死亡率很高。存活损伤的患者面临因异物侵入中枢神经系统（CNS）而感染的风险。关于抗菌预防在管理此类患者中的效用存在争议，如果是这样,使用哪种抗菌剂。
方法：我们回顾了我们机构的pTBI患者，并进行了PRISMA系统评价，以评估预防性抗生素对降低中枢神经系统感染风险的影响。
结果：我们在文献中确定了21例局部患者和327例患者。在我们的本地系列中，17名当地患者接受了预防性抗生素；4名没有。总的来说,这些患者中有5例（24％）发生了中枢神经系统感染（4例和1例实质内脑脓肿和脑膜炎，分别)。与接受预防性抗生素治疗的17例患者中的2例（12％）相比，未接受预防性抗生素治疗的所有4例患者均发生了感染（3例中枢神经系统感染；1例浅表伤口感染）。在文献报道的327例pTBI病例中，216（66％）接受预防性抗生素。38例（17％）接受抗生素治疗的患者发生了中枢神经系统感染，而21例（19％）未接受抗生素治疗的患者发生了中枢神经系统感染（p=0.76）。
结论：尽管我们对文献的回顾没有发现任何益处，我们的机构系列研究表明,pTBI患者可能受益于预防性抗生素.我们提出了一种简短的抗生素疗程，该疗程针对有或没有有机碎片的病例。
方法：我们回顾了我们机构的pTBI患者，并进行了PRISMA系统评价，以评估预防性抗生素对降低中枢神经系统感染风险的影响。
结果：我们在文献中确定了21例局部患者和327例患者。在我们的本地系列中，17名当地患者接受了预防性抗生素；4名没有。总的来说,这些患者中有5例（24％）发生了中枢神经系统感染（4例和1例实质内脑脓肿和脑膜炎，分别)。与接受预防性抗生素治疗的17例患者中的2例（12％）相比，未接受预防性抗生素治疗的所有4例患者均发生了感染（3例中枢神经系统感染；1例浅表伤口感染）。在文献报道的327例pTBI病例中，216（66％）接受预防性抗生素。38例（17％）接受抗生素治疗的患者发生了中枢神经系统感染，而21例（19％）未接受抗生素治疗的患者发生了中枢神经系统感染（p=0.76）。
结论：尽管我们对文献的回顾没有发现任何益处，我们的机构系列研究表明,pTBI患者可能受益于预防性抗生素.我们提出了一种简短的抗生素疗程，该疗程针对有或没有有机碎片的病例。
