Posttraumatic Meningitis

Baltas, Ioannis; Tsoulfa, Soultana; Sakellariou, Pavlos; Vogas, Vaggelis; Fylaktakis, Makedos; Kondodimou, Angeliki

doi:10.1097/00006123-199409000-00009

Cited by 7 publications

(3 citation statements)

References 20 publications

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“…S. pneumoniae and H. influenzae are two common bacteria that populate the head's cavities and are often causative agents in cases of posttraumatic meningitis, ventriculitis, encephalitis, and intracranial abscess. 1,2 Historically, patients with skull or facial fractures and evidence of traumatic pneumocephalus on head computed tomography (CT) were prophylactically treated with antibiotics to reduce this hypothetical risk. 3 However, prophylactic treatments for traumatic pneumocephalus vary widely among institutions, from no antibiotics to dual-antibiotic therapy, with little evidence in the existing literature to guide this practice.…”

Section: Introductionmentioning

confidence: 99%

Prophylactic Antibiotics in Patients with Traumatic Pneumocephalus or Cerebrospinal Fluid Leak

Wang

Reif

Kalkwarf

et al. 2022

The American Surgeon™

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Introduction 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. Methods 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. Results 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). Conclusion 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.

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Section: Introductionmentioning

confidence: 99%

Prophylactic Antibiotics in Patients with Traumatic Pneumocephalus or Cerebrospinal Fluid Leak

Wang

Reif

Kalkwarf

et al. 2022

The American Surgeon™

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“…Factors such as cerebrospinal fluid (CSF) fistula, basilar skull fracture, burr hole surgery in the emergency department, and decompressive craniectomy are associated with post-traumatic meningitis [ 1 ]. The vast majority of post-traumatic meningitides are caused by infectious pathogens, most commonly multi-drug-resistant (MDR) bacterial pathogens [ 2 ]. However, aseptic meningitis occurs less frequently due to tissue response to injury or stimulation by noninfectious agents [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Steroid-Responsive Post-Traumatic Persistent Neutrophilic Meningitis

Haddad

Sheybani

Olfati

et al. 2022

Case Reports in Medicine

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Post-traumatic meningitis is a potentially fatal condition that presents as a diagnostic and therapeutic challenge. The vast majority of post-traumatic meningitides are caused by infectious pathogens, most commonly multi-drug-resistant (MDR) bacterial pathogens. However, aseptic meningitis occurs less frequently due to tissue response to injury or stimulation by noninfectious agents, such as blood breakdown products or chemicals. Here, we present a case of post-traumatic persistent neutrophilic meningitis who was found to be steroid responsive. Diagnostic evaluation in our patient did not reveal any infectious pathogen, and the patient did not respond to broad-spectrum antimicrobial treatment. We suggest that physicians who treat patients with post-traumatic meningitis should consider steroid-responsive post-traumatic persistent neutrophilic meningitis (SPNM) in the list of differential diagnosis particularly when no infectious etiology is found and the patient does not respond to empirical antimicrobial treatment. Brain injury-induced immune dysregulation causing exaggerated inflammatory reaction might play a role in the pathogenesis of SPNM; however, further neuropathological studies are absolutely necessary to evaluate and characterize trauma-induced immune dysregulation.

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“…ІКЗУ, пов'язані з проведенням люмбальної пункції, виникають з частотою 1 на 50 000 (в США -приблизно у 80 хворих на рік) [9]. В нейротравматогії частота ІКЗУ після тяжкої або середньої тяжкості ЧМТ становить 1,4% [10], за відкритої ЧМТ -від 2 до 11% [11].…”

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Prevention of intracranial inflammatory complications in neurosurgery: literature review

Ткачик

2017

Ukr Neurosurg J

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Posttraumatic Meningitis

Cited by 7 publications

References 20 publications

Prophylactic Antibiotics in Patients with Traumatic Pneumocephalus or Cerebrospinal Fluid Leak

Prophylactic Antibiotics in Patients with Traumatic Pneumocephalus or Cerebrospinal Fluid Leak

Steroid-Responsive Post-Traumatic Persistent Neutrophilic Meningitis

Prevention of intracranial inflammatory complications in neurosurgery: literature review

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