Background:
The incidence of meningitis occurring after head trauma ranges from 1.4 to 10.6% in patients who receive antimicrobials. However, the efficacy of antimicrobial prophylaxis to prevent meningitis remains controversial due to low-quality clinical data.
A recent multicenter trial evaluated infection after penetrating brain injury5. Patients were stratified into two categories, those who received prophylactic antibiotics for penetrating brain injury, and those who did not. Antibiotic regimens and duration of prophylaxis was not well defined. Infection rate was 7% in patients who received antibiotics, compared with 6% in those who did not. The use of prophylactic antibiotics did not impact the rate of infection in the results of this study.
Meta-analyses describing the use of prophylactic antibiotics in the setting of basilar skull fractures failed to show a decrease in the incidence of meningitis compared to no antibiotics. However, clinical data suggests that the presence of a CSF leak is an additional risk factor for developing meningitis, and patients who present with a CSF leak may benefit from antibiotic prophylaxis.
This document is intended to serve only as a guideline based on current review of medical literature, and not intended to replace clinical judgment, physician/surgeon discretion, or special circumstances.
Resources:
1. Ratilal BO, Costa J, Pappamikail, et al. Antibiotic prophylaxis for preventing meningitis in patient with basilar skull fractures. Cochrane Database Sys Rev. 2015 Apr 28;(4): CD004884. doi: 10.1002/14651858.CD004884.pub4.
2. May AK, Fleming SB, Carpenter RO et al. Influence of broad-spectrum antibiotic prophylaxis on intracranial pressure monitor infections and subsequent infectious complications in head-injured patients. Surg Infect (Larchmt) 2006; 7:409-417.
3. Villalobos T, Arango C, Kubilis P et al. Antibiotic prophylaxis after basilar skull fractures: a meta-analysis. Clin Infect Dis 1998; 27:364-369.
4. Yellinek S, Cohen A, Merkin V, Shelef I, Benifla M. Clinical significance of skull base fracture in patients after traumatic brain injury. J Clin Neurosci. 2016;25:111–5.
5. Harmon LA, Haase DJ, Kufera JA, et al. Infection after penetrating brain injury—an Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15–19, 2019, in Austin, Texas. J Trauma Acute Care Surg. 2019;87(1):61–67.
November 28, 2020 (Dina Ali, A Bernard, Steph Priest); Review Ali/Olney 11-7-23
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