Adjunctive Intraventricular Antibiotic Therapy for Bacterial Central Nervous System Infections in Critically Ill Patients With Traumatic Brain Injury

Nicole McClellan, Joseph Swanson, Louis J. Magnotti, Terry W. Griffith, G Christopher Wood, Martin Croce, Bradley Boucher, Eric W. Mueller, Timothy Fabian

Research output: Contribution to journalArticle

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Abstract

Background: Limited data exist on the role of adjunctive intraventricular (IVT) antibiotics for the treatment of central nervous system (CNS) infections in traumatic brain injury (TBI) patients. Objective: To evaluate differences in CNS infection cure rates for TBI patients who received adjunctive IVT antibiotics compared with intravenous (IV) antibiotics alone. Methods: We retrospectively identified patients with TBI and bacterial CNS infections admitted to the trauma intensive care unit (ICU) from 1997 to 2013. Study patients received IV and IVT antibiotics, and control patients received IV antibiotics alone. Clinical and microbiological cure rates were determined from patient records, in addition to ICU and hospital lengths of stay (LOSs), ventilator days, and hospital mortality. Results: A total of 83 patients were enrolled (32 study and 51 control). The duration of IV antibiotics was similar in both groups (10 vs 12 days, P = 0.14), and the study group received IVT antibiotics for a median of 9 days. Microbiological cure rates were 84% and 82% in study and control groups, respectively (P = 0.95). Clinical cure rates were similar at all time points. No significant differences were seen in days of mechanical ventilation, ICU or hospital LOS, or hospital mortality. When only patients with external ventricular drains were compared, cure rates remained similar between groups. Conclusions: TBI patients with CNS infections had similar microbiological and clinical cure rates whether they were treated with adjunctive IVT antibiotics or IV antibiotics alone. Shorter than recommended durations of antibiotic therapy still resulted in acceptable cure rates and similar clinically relevant outcomes.

Original languageEnglish (US)
Pages (from-to)515-522
Number of pages8
JournalAnnals of Pharmacotherapy
Volume49
Issue number5
DOIs
StatePublished - May 22 2015

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Central Nervous System Bacterial Infections
Critical Illness
Anti-Bacterial Agents
Central Nervous System Infections
Length of Stay
Intensive Care Units
Therapeutics
Hospital Mortality
Traumatic Brain Injury
Mechanical Ventilators
Artificial Respiration

All Science Journal Classification (ASJC) codes

  • Pharmacology (medical)

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Adjunctive Intraventricular Antibiotic Therapy for Bacterial Central Nervous System Infections in Critically Ill Patients With Traumatic Brain Injury. / McClellan, Nicole; Swanson, Joseph; Magnotti, Louis J.; Griffith, Terry W.; Wood, G Christopher; Croce, Martin; Boucher, Bradley; Mueller, Eric W.; Fabian, Timothy.

In: Annals of Pharmacotherapy, Vol. 49, No. 5, 22.05.2015, p. 515-522.

Research output: Contribution to journalArticle

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