title: Infections in patients with traumatic brain injury who undergo neurosurgery.
abstract: OBJECTIVE
  Several factors place victims with traumatic brain injury (TBI) at increased risk for infection. The purpose of this study was to delineate the frequency, types and risk factors for infection in patients with TBI who undergo neurosurgery.
  
  
  METHODS
  Retrospective surveillance of infections in patients with TBI, aged  ≥18 years who underwent neurosurgery in University of Crete between 1999 and 2005.
  
  
  RESULTS
  Two hundred fifty-eight patients (76.7% men) who underwent 342 procedures were included. One hundred forty-two infections occurred, mainly lower respiratory tract infections (44.4% of the number of infections) and surgical site infections (SSIs) (25.4%). In multivariate analysis, SSIs were independently associated with the length of stay (p < 0.001), history of malignancy (p = 0.008), CSF leak (p = 0.012), any concomitant infection (p = 0.010), particularly urinary tract infections (p = 0.001) and the use of lumbar and/or ventricular drains (p = 0.005). Meningitis was independently associated with the total length of stay (p < 0.001), the need for intubation and mechanical ventilation beyond surgery (p = 0.028) and the presence of a lumbar and/or ventricular drain (p < 0.001).
  
  
  CONCLUSIONS
  Respiratory tract infections were common in patients with TBI who underwent surgery with Acinetobacter spp. being the emerging offending pathogens. Device-related postoperative communication of the CSF and the environment was a significant risk factor for SSI development and meningitis in particular. Malignancy was an independent risk factor for SSIs. The prevalence of the offending pathogens must be determined institution by institution for the establishment of proper antibiotic treatment on suspicion.
authors.affiliation: Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece. irenekourbeti@hotmail.com
authors.forename: Irene S
authors.initials: IS
authors.lastname: Kourbeti
authors.forename: John A
authors.initials: JA
authors.lastname: Papadakis
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Neophytou
authors.forename: Maria
authors.initials: M
authors.lastname: Filippou
authors.forename: Antonis
authors.initials: A
authors.lastname: Ioannou
authors.forename: Dimitris A
authors.initials: DA
authors.lastname: Karabetsos
authors.forename: George
authors.initials: G
authors.lastname: Bertsias
authors.forename: Maria
authors.initials: M
authors.lastname: Anastasaki
authors.forename: Antonis F
authors.initials: AF
authors.lastname: Vakis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000150:complications* / Q000453:epidemiology; D003428:Cross Infection; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology* / Q000382:microbiology / Q000401:mortality; D055815:Young Adult