Antibiotic prophylaxis for intracranial pressure monitors

To determined the safety and efficacy of prophylactic antibiotics in head-injured patients requiring intracranial pressure monitors, the files of 30 consecutive patients with isolated, severe head injuries admitted over a 1-year period were reviewed. Patients .15 years with severe closed-head injury who did not have severe concomitant, extracranial injury (Abbreviated Injury Score, 3) and survived .48 hours following hospital admission were included. Fourteen patients underwent intracranial pressure monitor placement and received prophylactic antibiotics for the duration of monitoring and the remaining 16 patients were neither monitored nor given prophylactic antibiotics. Length of hospital stay, length of intensive care stay, overall and septic complication rate, and death rate were compared for the two treatment groups. The groups were similar with regard to patient characteristics, associated injuries, and injury severity. Patients who received prophylactic antibiotics demonstrated statistically higher septic morbidity rates (78.6% versus 31.3%) and statistically higher pneumonia rates (57.1% versus 18.8%) compared with patients who did not. No patient developed central nervous system infection related to the monitor itself. These results indicate that the administration of prophylactic antibiotics to head-injured patients for the duration of intracranial pressure monitoring is unnecessary and potentially detrimental. Antibiotics, if given at all, should be limited to the period immediately surrounding intracranial pressure monitor placement.