ABSTRACT
Traumatic brain injury (TBI) represents an important risk factor for nosocomial infections.
This chapter focuses mainly on the appropriateness of antibiotic prophylaxis and the management of external ventricular drain (EVD) related infections, with an overview on ventilator-associated pneumonia (VAP), which represents the most common infection after TBI.
Basilar skull fractures, especially if associated with persisting cerebrospinal fluid (CSF) leakage, can be complicated by meningitis. Current evidence does not prove the effectiveness of antibiotic prophylaxis for preventing infection, whether there is CSF leakage or not.
Regarding penetrating brain injury, the presence of foreign objects poses a high risk of infection; debridement of contaminated tissue and broad-spectrum antibiotic prophylaxis are both recommended.
If an EVD is needed, periprocedural antibiotic prophylaxis is recommended, as well as the use of antimicrobial or silver-impregnated catheters and early removal. It is important to distinguish between contamination, colonization, and infection of CSF. Infection requires prompt antimicrobial therapy: An empirical strategy can be vancomycin, for high rates of staphylococcal infections, plus an antipseudomonal cephalosporin or carbapenem.
VAP is the most common nosocomial infection, which warrants specific prevention measures. Early therapy for VAP should be based on risk factors for multi-drug resistant bacteria and is subsequently re-evaluated according to antibiograms.
