Introduction

Infectious complications that follow trauma; 1) intracranial and 2)

extracranial

Infections may follow either minor or major trauma, maybe acute or

chronic, and may involve any part of the head from outer skin to the
parenchyma of the brain.

Requires an understanding of the principles of

antimicrobial therapy
Extracranial and Cranial Infections
WOUND INFECTIONS
• Approximately 1 percent of cases. (Narayan)
• In case-control series; risk factors associated with wound infections in over
9000 operations were (1) CSF leaks, (2) concomitant non-CNS infections, and
(3) perioperative infections. Over 60% of the reported postoperative wound
infections were due to Staphylococcus sp, and about 5 percent were due to
gram-negative bacilli, and the other factors are; placement of foreign
objects, a surgical procedure with paranasal sinus entry, and the post
operative drains.
• Early scalp wound infections after neurotrauma usually result from
insufficient wound debridement, and late scalp wound infections
maybe associated with systemic signs and symptoms of infection
 SUBGALEAL ABSCESS

• Bacteria inoculated into scalp laceration of puncture wound can grow

in the subgaleal spaces.

• The tx of choice is incision and drainage with irrigation of the abscess

cavity. Parenteral ABs should provide coverage for gram-positive cocci
and anaerobes, for 10-14 days
 OSTEOMYELITIS OF THE SKULL

• Relatively uncommon after cranial trauma.

• One large series reported by Bullitt and Lehman, only 3 of 18 px with
osteomyelitis of the skull had a history of cranial trauma.
• Most presentations: subacute, with sinus/incisional drainage, local
swelling, tenderness, headache – fever and malaise uncommon
• Usually because of Staphylococcus aureus and S. epidermidis
Intracranial Infections
MENINGITIS

Postraumatic Meningitis
• Incidence rate 0.2-17.8 percent
• CSF leak is a significant risk factor
• Rhinorrhea is a more common sign of CSF leak than otorrhea. The risk
of meningitis because of rhinorrhea is 3 times that otorrhea.
• The symptoms of posttraumatic meningitis are the same as those of
nontraumatic meningitis.
Postoperative Meningitis
• Incidence rate of postoperative meningitis after “clean” neurosurgery
has been reported to be approximately 0.5-0.7 percent, in clean-
contaminated cases the incidence is 0.4-2 percent
HOW??
• Using of external device (repeated flushing of these devices can lead
to a breakfown of sterile technique and may allow direct access of
bacteria into shunts)
Epidural and Subdural Abscess
• Epidural: Located between dura and the overlying bone
• Subdural: Located between dura mater and the arachnoid
surrounding the brain
• Most often complications of paranasal sinusitis but can occur after
head trauma, after neurosurgery, with osteomyelitis of the skull, or
after bacteremia from another focus.
• Male>Female
Clinical presentation:
• Fever and headache (90%)
• Nausea
• Vomiting
• Lethargy
• Papiledema found in one-third of these px

• Diagnosed by CT scan or MRI (more sensitive)

Brain Abscesses
• The most common sources of infections are ear, nose and throat.
• Neurosurgery and trauma account for 20% of brain abscesses
• In 10% cases no source is found.
• After penetrating injury the risk of brain absecess increases.
• Risk factors for brain abscess after cranial injury: (1) gunshot wounds,
(2) multiple injuries, (3) wound complications such as hematoma or
fluid collections
Clinical manifestations:
• Maybe subacute or acute and alarming.
• Triad: Fever – Headachae – Focal Neurological Deficits
• Nausea
• Vomiting
• Seizures
• Papiledema
• Most common are hemiplegia, and cranial nerve palsies
Surgical drainage of brain abscesses is recommended, but the timing
and the procedural to be used remain controversial. Stereotactic-
guided CT aspiration has been reported to be successful and provides a
specific bacteriological diagnosis in most cases.
 NOSOCOMIAL INFECTIONS

Study found that 10% of px admitted with acute head trayma developed a
nosocomial infection. And higher who those recieiving mechanical ventilation,
sterois, and certain other therapies.

• Urinary Tract Infections

40-60 cases, because the use of urinary catheter
E. Coli, P. aeruginosa, Enteroccus sp, yeasts and other negative grams are
most common found
• Pneumonia
Second most common cause of nosocomial infection and most frequent causing death

Aspiration pneumonia – small amounts of oropharyngeal or gastric contents occur

frequently during sleep or during surgery – Blockage Airway – Hypoxia

Ventilator-Associated pneumonia – incidence 7fold – 21-fold compared with

nonintubated px. Because of mechanical irritation of the respiratory mucosa that allow
increasedcolonization with potential bacterial pathogens and may serve of bacterial
contaminants. Incidence rate is 3-54%, risk factor is; prolonged mechanical ventilation
(>3 days)
 DECUBITUS ULCERS

Or pressures sores.
The broken in the body’s barrier defense system and is associated with
a number of infections, osteomyelitis and bacteremia.
Usually in bony area like sacrum, coccyx, trochanter major of femur,
and ischial tuberosities
Principles of Antimicrobial Therapy
Blood-Brain Barrier

• Four major characteristics of

antimicrobial agents affect
passage into the CSF: (1) lipid
solubility, (2) degree of
ionization, (3) degree of serum
protein binding and (4)
molecular weight
Specific Antimicrobial Agents
Thank you