Publication year: 2012
Source:World Neurosurgery
Carlos Mario Jimenez, Jonathan Polo, Julian Andres España
Objective To determine risk factors for intracranial infection secondary to penetrating craniocerebral gunshot wounds (PCGW) in civilian practice, in patients who underwent surgery with removal of bullet fragments, wound debridement and watertight dural closure. Methods An observational, analytical, prospective, cohort-type study was conducted with follow-up to a group of patients with PCGW caused by low velocity projectile admitted between January 2000 and November 2010. Patients were included in a 160-patient study, 59 of whom were administered prophylactic antibiotics based on the treating neurosurgeon's decision. Average follow-up time was 39 months (range: 3 – 92 months). Results 40 patients (25%) showed infection; 20 patients received antibiotics (20/59, 33.9%), and 20 patients did not receive antibiotics (20/101, 19.8%). Three variables were independent risk factors for infection: Persistence of parenchymal osseous or metallic fragments after surgery (p<0.0001. RR: 7.45), projective trajectory through a natural cavity with contaminating flora (p: 0.03, RR: 2.84), and prolonged hospitalization time (p<0.0001, RR: 3.695). Conclusion Administration of prophylactic antibiotics was not associated to the incidence of intracranial infection secondary to PCGW. Projectile trajectory through potentially contaminating cavities, persistence of intra-parenchymal osseous or metallic fragments after surgery and prolonged hospital stay were independent risk factors for such an infection.
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