Single-Center Experience With Antibiotic Prophylaxis and Infectious Complications in Civilian Cranial Gunshot Wounds

Despite the widespread adoption of systemic antibiotic prophylaxis in civilian cranial gunshot wounds (cGSWs), there remains a lack of consensus on microbial coverage and duration of therapy. To analyze a 6-yr experience with prophylactic antibiotics in civilian cGSWs with a focus on infectious complications. Records were reviewed for demographic and injury characteristics that could influence the risk of intracranial infection. Patients over 16 yr of age with cGSWs who survived more than 48 h were included. Antimicrobial prophylaxis was initiated at the discretion of the treating neurosurgeon, with eligible patients divided into 3 groups: no prophylaxis, single agent, and multiagent. Univariate analysis and multivariable logistic regression were performed to determine variables contributing to the development of intracranial infection. Of 75 eligible patients, prophylactic antibiotics were utilized in 61 (81.3%) with a 5 d median duration. Injury Severity Score (ISS) was significantly higher and Glasgow Coma Scale (GCS) was significantly lower in those who received prophylaxis. Eight intracranial infections were documented (10.7%) over a range of 1 wk to 3 yr from injury. Antibiotic prophylaxis did not contribute to infection, but the presence of cerebrospinal fluid (CSF) leak was associated with intracranial infection risk in multivariable regression (odds ratio [OR] = 11.8, P = .013). In a cohort of cGSW patients, those with a more severe injury profile were more likely to receive multiagent antimicrobial prophylaxis. However, we found that multiagent antimicrobial prophylaxis did not confer an advantage, and that the presence of CSF leak may be a more important contributing variable to the development of intracranial infection.