Patients with traumatic brain injuries are at increased risk for CNS infections. Several factors increase the risk. Skull fractures and CSF leaks, as discussed earlier, are risk factors for developing meningitis. In addition to CNS infections, patients intubated and on neuromuscular blockade are shown to have longer ICU stays, an increased risk for aspiration pneumonias, and, tend toward sepsis. Due to controversies regarding use of prophylactic antibiotics, consultation with the neurosurgeon or intensivist should be obtained prior to their administration.
Patients who present with a history of a skull fracture and fever or other symptoms of meningitis should be treated with antibiotics. The source of infection depends on the time since the injury. Within 72 hours, pneumococcus is generally the cause. After that, gram-negative organisms and Staphylococcus aureus become more common. Patients should given vancomycin and a third-generation cephalosporin, such as ceftazidime, until cultures confirm the cause.
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