Open skull fractures and sepsis: Evidence towards a targeted antibiotic prophylactic recommendation

Abstract

Background and objectives: Although patients with weapon-induced open skull fractures benefit from antibiotic prophylaxis, there is limited data on microbiological factors associated with such injuries. This study considers the most prominent bacteria cultured, alongside their antibiotic resistance profiles and factors relating to wound infection for insights into a targeted clinical management recommendation in patients suffering from assault-related open skull fractures.

Methods: Patients with weapon-induced traumatic head injuries and infective complications were analysed (n = 108) regarding factors impacting the peri-operative period, bacterial samples cultured, and the associated clinical outcomes, together with antibiotic susceptibility testing for all bacterial cultures. The relevant variables were analysed using descriptive statistics and a Pearson Chi-Square statistical test.

Results: Antibiotic prophylaxis significantly reduced infective complications in open skull fractures. Staphylococcus aureus, Streptococcus spp., Acinetobacter baumanii, Enterobacter spp., and Enterococcus spp. were the main organisms cultured in the wounds in this study population. Scalp tissue specimens produced the most positive culture rates (84.6 %). Within post-operative clinical outcomes, S. aureus-culture positive patients were associated with developing systemic sepsis, or a superficial wound infection. Patients with positive Streptococcus spp. or A. baumanii cultures were more likely to be associated with developing systemic sepsis, whereas Enterobacter spp. and Enterococcus spp. was not associated with a particular infective complication subtype. Antibiotic resistance comparable with the international resistance profiles was noted in S. aureus, Enterobacter spp. and A. baumanii.

Conclusion: Key factors for consideration are highlighted and the use of Cefazolin and Gentamycin as targeted antibiotic prophylaxis in patients with traumatic head injuries following weapon assault is recommended.

Keywords: Bacterial Resistance; Brain Trauma Foundation; Fourth edition; Neurosurgery; Trauma.