Infection After Penetrating Brain Injury: An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15-19, 2019, in Austin, Texas

Laura A. Harmon; Daniel J. Haase; Joseph A. Kufera; Sakib Adnan; Donna Cabral; Lawrence Lottenberg; Kyle W. Cunningham; Stephanie Bonne; Jessica Burgess; Jennifer L. Rehbein; Gregory Semon; Matthew R. Noorbakhsh; Benjamin N. Cragun; Vaidehi Agrawal; Michael Truitt; Joseph Marcotte; Anna Goldenberg; Milad Behbahaninia; Natasha Keric; Peter M. Hammer; Jeffry Nahmias; Areg Grigorian; Dave Turay; Vikram Chakravarthy; Priti Lalchandani; Dennis Kim; Trinette Chapin; Julie Dunn; Victor Portillo; Thomas Schroeppel; Deborah M. Stein

doi:10.1097/TA.0000000000002327

Infection After Penetrating Brain Injury: An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15-19, 2019, in Austin, Texas

Laura A. Harmon, Daniel J. Haase, Joseph A. Kufera, Sakib Adnan, Donna Cabral, Lawrence Lottenberg, Kyle W. Cunningham, Stephanie Bonne, Jessica Burgess, Jennifer L. Rehbein, Gregory Semon, Matthew R. Noorbakhsh, Benjamin N. Cragun, Vaidehi Agrawal, Michael Truitt, Joseph Marcotte, Anna Goldenberg, Milad Behbahaninia, Natasha Keric, Peter M. HammerJeffry Nahmias, Areg Grigorian, Dave Turay, Vikram Chakravarthy, Priti Lalchandani, Dennis Kim, Trinette Chapin, Julie Dunn, Victor Portillo, Thomas Schroeppel, Deborah M. Stein

Surgery

Research output: Contribution to journal › Meeting abstract › peer-review

Abstract

<p> 2019 EAST PODIUM PAPER <h1> Infection after penetrating brain injury—An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15–19, 2019, in Austin, Texas </h1> <p id="x-x-P7"> Harmon, Laura A. MD; Haase, Daniel J. MD; Kufera, Joseph A. MA; Adnan, Sakib BS; Cabral, Donna BNS; Lottenberg, Lawrence MD; Cunningham, Kyle W. MD, MPH; Bonne, Stephanie MD; Burgess, Jessica MD; Etheridge, James MD; Rehbein, Jennifer L. MD; Semon, Gregory DO; Noorbakhsh, Matthew R. MD; Cragun, Benjamin N. MD; Agrawal, Vaidehi PhD; Truitt, Michael MD; Marcotte, Joseph MD; Goldenberg, Anna DO; Behbahaninia, Milad MD; Keric, Natasha MD; Hammer, Peter M. MD; Nahmias, Jeffry MD; Grigorian, Areg MD; Turay, Dave MD; Chakravarthy, Vikram MD; Lalchandani, Priti MD; Kim, Dennis MD; Chapin, Trinette; Dunn, Julie MD; Portillo, Victor MD; Schroeppel, Thomas MD, MS; Stein, Deborah M. MD, MPH <a href="https://journals.lww.com/jtrauma/abstract/2019/07000/infection_after_penetrating_brain_injury_an.9.aspx#" id="x-x-ejp-article-authors-link"> Author Information <em> </em> </a> Journal of Trauma and Acute Care Surgery <a href="https://journals.lww.com/jtrauma/toc/2019/07000"> 87(1):p 61-67, July 2019. </a> | DOI: 10.1097/TA.0000000000002327 <ul> <li id="x-x-ej-article-indicators-buy"> <a href="https://journals.lww.com/jtrauma/abstract/2019/07000/infection_after_penetrating_brain_injury_an.9.aspx#ContentAccessOptions"> Buy </a> </li> <li id="x-x-ej-article-indicators-cme"> CME Test </li> <li id="x-x-ej-article-indicators-erratum"> <a href="https://journals.lww.com/jtrauma/abstract/2019/07000/infection_after_penetrating_brain_injury_an.9.aspx#errata"> Erratum </a> </li> </ul> <h2> Abstract </h2> <h3> BACKGROUND </h3> </p> <p> Fatality rates following penetrating traumatic brain injury (pTBI) are extremely high and survivors are often left with significant disability. Infection following pTBI is associated with worse morbidity. The modern rates of central nervous system infections (INF) in civilian survivors are unknown. This study sought to determine the rate of and risk factors for INF following pTBI and to determine the impact of antibiotic prophylaxis. <h3> METHODS </h3> </p> <p> Seventeen institutions submitted adult patients with pTBI and survival of more than 72 hours from 2006 to 2016. Patients were stratified by the presence or absence of infection and the use or omission of prophylactic antibiotics. Study was powered at 85% to detect a difference in infection rate of 5%. Primary endpoint was the impact of prophylactic antibiotics on INF. Mantel-Haenszel χ <sup> 2 </sup> and Wilcoxon's rank-sum tests were used to compare categorical and nonparametric variables. Significance greater than <em> p </em> = 0.2 was included in a logistic regression adjusted for center. <h3> RESULTS </h3> </p> <p> Seven hundred sixty-three patients with pTBI were identified over 11 years. 7% (n = 51) of patients developed an INF. Sixty-six percent of INF patients received prophylactic antibiotics. Sixty-two percent of all patients received one dose or greater of prophylactic antibiotics and 50% of patients received extended antibiotics. Degree of dural penetration did not appear to impact the incidence of INF ( <em> p </em> = 0.8) nor did trajectory through the oropharynx ( <em> p </em> = 0.18). Controlling for other variables, there was no statistically significant difference in INF with the use of prophylactic antibiotics ( <em> p </em> = 0.5). Infection was higher in patients with intracerebral pressure monitors (4% vs. 12%; <em> p </em> = <0.001) and in patients with surgical intervention (10% vs. 3%; <em> p </em> < 0.001). <h3> CONCLUSION </h3> </p> <p> There is no reduction in INF with prophylactic antibiotics in pTBI. Surgical intervention and invasive intracerebral pressure monitoring appear to be risk factors for INF regardless of prophylactic use. <h3> LEVEL OF EVIDENCE </h3> </p> <p> Therapeutic, level IV. </p></p>

Original language	English
Pages (from-to)	61-67
Number of pages	7
Journal	Journal of Trauma and Acute Care Surgery
Volume	87
Issue number	1
DOIs	https://doi.org/10.1097/TA.0000000000002327
State	Published - Jul 2019
Event	32nd Annual Meeting of the Eastern Association for the Surgery of Trauma - Austin, United States Duration: Jan 15 2019 → Jan 19 2019 Conference number: 32

ASJC Scopus Subject Areas

Surgery
Critical Care and Intensive Care Medicine

Keywords

Antibiotics
Head Injuries, Penetrating/complications
Infections
Intervention
Penetrating brain injruy

Disciplines

Surgery

Access to Document

10.1097/TA.0000000000002327License: Unspecified

Cite this

Harmon, L. A., Haase, D. J., Kufera, J. A., Adnan, S., Cabral, D., Lottenberg, L., Cunningham, K. W., Bonne, S., Burgess, J., Rehbein, J. L., Semon, G., Noorbakhsh, M. R., Cragun, B. N., Agrawal, V., Truitt, M., Marcotte, J., Goldenberg, A., Behbahaninia, M., Keric, N., ... Stein, D. M. (2019). Infection After Penetrating Brain Injury: An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15-19, 2019, in Austin, Texas. Journal of Trauma and Acute Care Surgery, 87(1), 61-67. https://doi.org/10.1097/TA.0000000000002327

Infection After Penetrating Brain Injury: An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15-19, 2019, in Austin, Texas. / Harmon, Laura A.; Haase, Daniel J.; Kufera, Joseph A. et al.
In: Journal of Trauma and Acute Care Surgery, Vol. 87, No. 1, 07.2019, p. 61-67.

Research output: Contribution to journal › Meeting abstract › peer-review

Harmon, LA, Haase, DJ, Kufera, JA, Adnan, S, Cabral, D, Lottenberg, L, Cunningham, KW, Bonne, S, Burgess, J, Rehbein, JL, Semon, G, Noorbakhsh, MR, Cragun, BN, Agrawal, V, Truitt, M, Marcotte, J, Goldenberg, A, Behbahaninia, M, Keric, N, Hammer, PM, Nahmias, J, Grigorian, A, Turay, D, Chakravarthy, V, Lalchandani, P, Kim, D, Chapin, T, Dunn, J, Portillo, V, Schroeppel, T & Stein, DM 2019, 'Infection After Penetrating Brain Injury: An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15-19, 2019, in Austin, Texas', Journal of Trauma and Acute Care Surgery, vol. 87, no. 1, pp. 61-67. https://doi.org/10.1097/TA.0000000000002327

Harmon LA, Haase DJ, Kufera JA, Adnan S, Cabral D, Lottenberg L et al. Infection After Penetrating Brain Injury: An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15-19, 2019, in Austin, Texas. Journal of Trauma and Acute Care Surgery. 2019 Jul;87(1):61-67. doi: 10.1097/TA.0000000000002327

Harmon, Laura A. ; Haase, Daniel J. ; Kufera, Joseph A. et al. / Infection After Penetrating Brain Injury : An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15-19, 2019, in Austin, Texas. In: Journal of Trauma and Acute Care Surgery. 2019 ; Vol. 87, No. 1. pp. 61-67.

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title = "Infection After Penetrating Brain Injury: An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15-19, 2019, in Austin, Texas",

abstract = " 2019 EAST PODIUM PAPER Infection after penetrating brain injury—An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15–19, 2019, in Austin, Texas Harmon, Laura A. MD; Haase, Daniel J. MD; Kufera, Joseph A. MA; Adnan, Sakib BS; Cabral, Donna BNS; Lottenberg, Lawrence MD; Cunningham, Kyle W. MD, MPH; Bonne, Stephanie MD; Burgess, Jessica MD; Etheridge, James MD; Rehbein, Jennifer L. MD; Semon, Gregory DO; Noorbakhsh, Matthew R. MD; Cragun, Benjamin N. MD; Agrawal, Vaidehi PhD; Truitt, Michael MD; Marcotte, Joseph MD; Goldenberg, Anna DO; Behbahaninia, Milad MD; Keric, Natasha MD; Hammer, Peter M. MD; Nahmias, Jeffry MD; Grigorian, Areg MD; Turay, Dave MD; Chakravarthy, Vikram MD; Lalchandani, Priti MD; Kim, Dennis MD; Chapin, Trinette; Dunn, Julie MD; Portillo, Victor MD; Schroeppel, Thomas MD, MS; Stein, Deborah M. MD, MPH Author Information Journal of Trauma and Acute Care Surgery 87(1):p 61-67, July 2019. | DOI: 10.1097/TA.0000000000002327 Buy CME Test Erratum Abstract BACKGROUND Fatality rates following penetrating traumatic brain injury (pTBI) are extremely high and survivors are often left with significant disability. Infection following pTBI is associated with worse morbidity. The modern rates of central nervous system infections (INF) in civilian survivors are unknown. This study sought to determine the rate of and risk factors for INF following pTBI and to determine the impact of antibiotic prophylaxis. METHODS Seventeen institutions submitted adult patients with pTBI and survival of more than 72 hours from 2006 to 2016. Patients were stratified by the presence or absence of infection and the use or omission of prophylactic antibiotics. Study was powered at 85% to detect a difference in infection rate of 5%. Primary endpoint was the impact of prophylactic antibiotics on INF. Mantel-Haenszel χ 2 and Wilcoxon's rank-sum tests were used to compare categorical and nonparametric variables. Significance greater than p = 0.2 was included in a logistic regression adjusted for center. RESULTS Seven hundred sixty-three patients with pTBI were identified over 11 years. 7% (n = 51) of patients developed an INF. Sixty-six percent of INF patients received prophylactic antibiotics. Sixty-two percent of all patients received one dose or greater of prophylactic antibiotics and 50% of patients received extended antibiotics. Degree of dural penetration did not appear to impact the incidence of INF ( p = 0.8) nor did trajectory through the oropharynx ( p = 0.18). Controlling for other variables, there was no statistically significant difference in INF with the use of prophylactic antibiotics ( p = 0.5). Infection was higher in patients with intracerebral pressure monitors (4% vs. 12%; p = <0.001) and in patients with surgical intervention (10% vs. 3%; p < 0.001). CONCLUSION There is no reduction in INF with prophylactic antibiotics in pTBI. Surgical intervention and invasive intracerebral pressure monitoring appear to be risk factors for INF regardless of prophylactic use. LEVEL OF EVIDENCE Therapeutic, level IV. ",

keywords = "Antibiotics, Head Injuries, Penetrating/complications, Infections, Intervention, Penetrating brain injruy",

author = "Harmon, {Laura A.} and Haase, {Daniel J.} and Kufera, {Joseph A.} and Sakib Adnan and Donna Cabral and Lawrence Lottenberg and Cunningham, {Kyle W.} and Stephanie Bonne and Jessica Burgess and Rehbein, {Jennifer L.} and Gregory Semon and Noorbakhsh, {Matthew R.} and Cragun, {Benjamin N.} and Vaidehi Agrawal and Michael Truitt and Joseph Marcotte and Anna Goldenberg and Milad Behbahaninia and Natasha Keric and Hammer, {Peter M.} and Jeffry Nahmias and Areg Grigorian and Dave Turay and Vikram Chakravarthy and Priti Lalchandani and Dennis Kim and Trinette Chapin and Julie Dunn and Victor Portillo and Thomas Schroeppel and Stein, {Deborah M.}",

note = "Publisher Copyright: {\textcopyright} Wolters Kluwer Health, Inc. All rights reserved.; 32nd Annual Meeting of the Eastern Association for the Surgery of Trauma ; Conference date: 15-01-2019 Through 19-01-2019",

year = "2019",

month = jul,

doi = "10.1097/TA.0000000000002327",

language = "English",

volume = "87",

pages = "61--67",

journal = "Journal of Trauma and Acute Care Surgery",

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TY - JOUR

T1 - Infection After Penetrating Brain Injury

T2 - 32nd Annual Meeting of the Eastern Association for the Surgery of Trauma

AU - Harmon, Laura A.

AU - Haase, Daniel J.

AU - Kufera, Joseph A.

AU - Adnan, Sakib

AU - Cabral, Donna

AU - Lottenberg, Lawrence

AU - Cunningham, Kyle W.

AU - Bonne, Stephanie

AU - Burgess, Jessica

AU - Rehbein, Jennifer L.

AU - Semon, Gregory

AU - Noorbakhsh, Matthew R.

AU - Cragun, Benjamin N.

AU - Agrawal, Vaidehi

AU - Truitt, Michael

AU - Marcotte, Joseph

AU - Goldenberg, Anna

AU - Behbahaninia, Milad

AU - Keric, Natasha

AU - Hammer, Peter M.

AU - Nahmias, Jeffry

AU - Grigorian, Areg

AU - Turay, Dave

AU - Chakravarthy, Vikram

AU - Lalchandani, Priti

AU - Kim, Dennis

AU - Chapin, Trinette

AU - Dunn, Julie

AU - Portillo, Victor

AU - Schroeppel, Thomas

AU - Stein, Deborah M.

N1 - Conference code: 32

PY - 2019/7

Y1 - 2019/7

N2 - 2019 EAST PODIUM PAPER Infection after penetrating brain injury—An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15–19, 2019, in Austin, Texas Harmon, Laura A. MD; Haase, Daniel J. MD; Kufera, Joseph A. MA; Adnan, Sakib BS; Cabral, Donna BNS; Lottenberg, Lawrence MD; Cunningham, Kyle W. MD, MPH; Bonne, Stephanie MD; Burgess, Jessica MD; Etheridge, James MD; Rehbein, Jennifer L. MD; Semon, Gregory DO; Noorbakhsh, Matthew R. MD; Cragun, Benjamin N. MD; Agrawal, Vaidehi PhD; Truitt, Michael MD; Marcotte, Joseph MD; Goldenberg, Anna DO; Behbahaninia, Milad MD; Keric, Natasha MD; Hammer, Peter M. MD; Nahmias, Jeffry MD; Grigorian, Areg MD; Turay, Dave MD; Chakravarthy, Vikram MD; Lalchandani, Priti MD; Kim, Dennis MD; Chapin, Trinette; Dunn, Julie MD; Portillo, Victor MD; Schroeppel, Thomas MD, MS; Stein, Deborah M. MD, MPH Author Information Journal of Trauma and Acute Care Surgery 87(1):p 61-67, July 2019. | DOI: 10.1097/TA.0000000000002327 Buy CME Test Erratum Abstract BACKGROUND Fatality rates following penetrating traumatic brain injury (pTBI) are extremely high and survivors are often left with significant disability. Infection following pTBI is associated with worse morbidity. The modern rates of central nervous system infections (INF) in civilian survivors are unknown. This study sought to determine the rate of and risk factors for INF following pTBI and to determine the impact of antibiotic prophylaxis. METHODS Seventeen institutions submitted adult patients with pTBI and survival of more than 72 hours from 2006 to 2016. Patients were stratified by the presence or absence of infection and the use or omission of prophylactic antibiotics. Study was powered at 85% to detect a difference in infection rate of 5%. Primary endpoint was the impact of prophylactic antibiotics on INF. Mantel-Haenszel χ 2 and Wilcoxon's rank-sum tests were used to compare categorical and nonparametric variables. Significance greater than p = 0.2 was included in a logistic regression adjusted for center. RESULTS Seven hundred sixty-three patients with pTBI were identified over 11 years. 7% (n = 51) of patients developed an INF. Sixty-six percent of INF patients received prophylactic antibiotics. Sixty-two percent of all patients received one dose or greater of prophylactic antibiotics and 50% of patients received extended antibiotics. Degree of dural penetration did not appear to impact the incidence of INF ( p = 0.8) nor did trajectory through the oropharynx ( p = 0.18). Controlling for other variables, there was no statistically significant difference in INF with the use of prophylactic antibiotics ( p = 0.5). Infection was higher in patients with intracerebral pressure monitors (4% vs. 12%; p = <0.001) and in patients with surgical intervention (10% vs. 3%; p < 0.001). CONCLUSION There is no reduction in INF with prophylactic antibiotics in pTBI. Surgical intervention and invasive intracerebral pressure monitoring appear to be risk factors for INF regardless of prophylactic use. LEVEL OF EVIDENCE Therapeutic, level IV.

AB - 2019 EAST PODIUM PAPER Infection after penetrating brain injury—An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15–19, 2019, in Austin, Texas Harmon, Laura A. MD; Haase, Daniel J. MD; Kufera, Joseph A. MA; Adnan, Sakib BS; Cabral, Donna BNS; Lottenberg, Lawrence MD; Cunningham, Kyle W. MD, MPH; Bonne, Stephanie MD; Burgess, Jessica MD; Etheridge, James MD; Rehbein, Jennifer L. MD; Semon, Gregory DO; Noorbakhsh, Matthew R. MD; Cragun, Benjamin N. MD; Agrawal, Vaidehi PhD; Truitt, Michael MD; Marcotte, Joseph MD; Goldenberg, Anna DO; Behbahaninia, Milad MD; Keric, Natasha MD; Hammer, Peter M. MD; Nahmias, Jeffry MD; Grigorian, Areg MD; Turay, Dave MD; Chakravarthy, Vikram MD; Lalchandani, Priti MD; Kim, Dennis MD; Chapin, Trinette; Dunn, Julie MD; Portillo, Victor MD; Schroeppel, Thomas MD, MS; Stein, Deborah M. MD, MPH Author Information Journal of Trauma and Acute Care Surgery 87(1):p 61-67, July 2019. | DOI: 10.1097/TA.0000000000002327 Buy CME Test Erratum Abstract BACKGROUND Fatality rates following penetrating traumatic brain injury (pTBI) are extremely high and survivors are often left with significant disability. Infection following pTBI is associated with worse morbidity. The modern rates of central nervous system infections (INF) in civilian survivors are unknown. This study sought to determine the rate of and risk factors for INF following pTBI and to determine the impact of antibiotic prophylaxis. METHODS Seventeen institutions submitted adult patients with pTBI and survival of more than 72 hours from 2006 to 2016. Patients were stratified by the presence or absence of infection and the use or omission of prophylactic antibiotics. Study was powered at 85% to detect a difference in infection rate of 5%. Primary endpoint was the impact of prophylactic antibiotics on INF. Mantel-Haenszel χ 2 and Wilcoxon's rank-sum tests were used to compare categorical and nonparametric variables. Significance greater than p = 0.2 was included in a logistic regression adjusted for center. RESULTS Seven hundred sixty-three patients with pTBI were identified over 11 years. 7% (n = 51) of patients developed an INF. Sixty-six percent of INF patients received prophylactic antibiotics. Sixty-two percent of all patients received one dose or greater of prophylactic antibiotics and 50% of patients received extended antibiotics. Degree of dural penetration did not appear to impact the incidence of INF ( p = 0.8) nor did trajectory through the oropharynx ( p = 0.18). Controlling for other variables, there was no statistically significant difference in INF with the use of prophylactic antibiotics ( p = 0.5). Infection was higher in patients with intracerebral pressure monitors (4% vs. 12%; p = <0.001) and in patients with surgical intervention (10% vs. 3%; p < 0.001). CONCLUSION There is no reduction in INF with prophylactic antibiotics in pTBI. Surgical intervention and invasive intracerebral pressure monitoring appear to be risk factors for INF regardless of prophylactic use. LEVEL OF EVIDENCE Therapeutic, level IV.

KW - Antibiotics

KW - Head Injuries, Penetrating/complications

KW - Infections

KW - Intervention

KW - Penetrating brain injruy

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C2 - 31033883

SN - 2163-0755

VL - 87

SP - 61

EP - 67

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

IS - 1

Y2 - 15 January 2019 through 19 January 2019

ER -

Infection After Penetrating Brain Injury: An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15-19, 2019, in Austin, Texas

Abstract

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