Comparative study on infection of the central nervous system in patients with head trauma and spontaneous cerebral hemorrhage

Introduction

The emergency neurosurgical procedure, the long duration of it (>4 hours) and the infected trauma are factors that have, in studies, been connected with increased probability of infection of the central nervous system (CNS) during the postoperative period.

Objective

To study the appearance of infection of the CNS in patients who have been operated on after sustaining a head injury or spontaneous cerebral hemorrhage that were hospitalized in the ICU, over a period of 2 years.

Materials

Recordings of 118 patients who were hospitalized in the ICU during the period 2005–2007. The selection of the patients was based on the following criteria: the reason for admission to the ICU was head injury (70 patients) or cerebral hemorrhage (48 patients); all patients had undergone a neurosurgical procedure; and an infection occurred during hospitalization in the ICU.

Methods

All patients out of the 118 that presented fever or laboratory findings of an infection which could not be attributed to an infection of any other reason except CNS underwent lumbar puncture.

Results

Twenty-seven patients underwent lumbar puncture (22.88%). Findings from the lumbar puncture compatible with an infection of the CNS occurred in six patients (five patients with cerebral injury and one patient with cerebral hemorrhage) out of 118 patients, 5.08% of all patients (7.14% of head injury and 2.08% of cerebral hemorrhages).

The days that the lumbar puncture was performed were the 4th–19th postoperative days. The mean GCS value during the admittance to the hospital of the total patients was 8.88 (3–15), but the mean GCS value of those patients that developed CNS infection was 7.86 (3–14).

Conclusion

The administration of antibiotics from the first day of admittance to the ICU probably is accountable for the very low rate of infection of the CNS in patients with head injury or cerebral hemorrhage. There is no important difference between the scheduled surgical procedure from the head injury and automatic cerebral hemorrhage. Further studies are needed for the reduction and control of the postoperative infections in these patients.