Antibiotic prophylaxis for patients with acute brain injury

Severe, acute brain injury is associated with a very high risk of ventilator-associated pneumonia (VAP). Approximately one-third of patients with acute brain injury will develop VAP, typically within the first week of illness. 1 Sirvent JM Torres A El-Ebiary M Castro P de Batlle J Bonet A Protective effect of intravenously administered cefuroxime against nosocomial pneumonia in patients with structural coma. Am J Respir Crit Care Med. 1997; 155: 1729-1734 Crossref PubMed Google Scholar , 2 Acquarolo A Urli T Perone G Giannotti C Candiani A Latronico N Antibiotic prophylaxis of early onset pneumonia in critically ill comatose patients. A randomized study. Intensive Care Med. 2005; 31: 510-516 Crossref PubMed Scopus (79) Google Scholar , 3 Francois B Cariou A Clere-Jehl R et al. Prevention of early ventilator-associated pneumonia after cardiac arrest. N Engl J Med. 2019; 381: 1831-1842 Crossref PubMed Scopus (80) Google Scholar , 4 Mirtalaei N Farazi A Ebrahimi Monfared M Jokar A Efficacy of antibiotic prophylaxis against ventilator-associated pneumonia. J Hosp Infect. 2019; 101: 272-275 Summary Full Text Full Text PDF PubMed Google Scholar The high risk of VAP is presumed to be due to loss of airway control leading to aspiration at the time of injury, inoculation during emergent intubation, or prolonged mechanical ventilation, and possibly due to immune suppression associated with critical illness. The development of pneumonia is associated with multiple negative outcomes, including more time on mechanical ventilation, increased hospital length of stay, worse neurological outcomes, and higher mortality. 1 Sirvent JM Torres A El-Ebiary M Castro P de Batlle J Bonet A Protective effect of intravenously administered cefuroxime against nosocomial pneumonia in patients with structural coma. Am J Respir Crit Care Med. 1997; 155: 1729-1734 Crossref PubMed Google Scholar , 5 Kumar RG Kesinger MR Juengst SB et al. Effects of hospital-acquired pneumonia on long-term recovery and hospital resource utilization following moderate to severe traumatic brain injury. J Trauma Acute Care Surg. 2020; 88: 491-500 Crossref PubMed Scopus (0) Google Scholar Ceftriaxone to prevent early ventilator-associated pneumonia in patients with acute brain injury: a multicentre, randomised, double-blind, placebo-controlled, assessor-masked superiority trialIn patients with acute brain injury, a single ceftriaxone dose decreased the risk of early VAP. On the basis of our findings, we recommend that an early, single dose of ceftriaxone be included in all bundles for the prevention of VAP in patients with brain injury who require mechanical ventilation. Full-Text PDF