N. K. Dhillon1, S. Sahi2, G. Barmparas1, N. T. Linaval1, T. Lin1, S. Lahiri1, C. V. Brown2, E. J. Ley1 1Cedars-Sinai Medical Center,Los Angeles, CA, USA 2Dell Medical School, University of Texas at Austin,Austin, TEXAS, USA
Introduction: Patients with traumatic brain injury (TBI) frequently develop leukocytosis, fever, and tachycardia which may lead to extensive medical investigations to rule out an infectious process. Cerebral spinal fluid (CSF) is often acquired during this work-up, however the utility of this practice has not been previously studied. We hypothesized that CSF cultures would unlikely yield positive results in patients with TBI.
Methods: A retrospective review was conducted of all TBI patients admitted to two Level 1 trauma center at an urban, academic medical center from 01/2009 to 12/2016. Data collected included patient demographics, presenting GCS, injury profile, injury severity scores (ISS), regional abbreviated injury scale (AIS), hospital and ICU length of stay (LOS), ventilator days, and culture results. For purposes of the analysis, CSF cultures with Staphylcoccus epidermidis, Staphylococcus aureus, or Candida were considered contaminated and deemed negative.
Results: There were 148 patients who had CSF cultures obtained with a median age of 40 years and 77.7% being male. The majority of patients presented following blunt trauma with median GCS of 6, head AIS of 4, and ISS of 26. These patients had prolonged median ICU and hospital stay at 14 and 22 days, respectively. Seven (4.7%) CSF cultures demonstrated growth. Four (2.7%) were deemed to be contaminants, with two growing Staphylcoccus epidermidis only, one with both Staphylcoccus epidermidis and Staphylococcus aureus, and one with Candida. Three cultures (2.0%) were positive; two had Enterobacter Cloacae and one Klebsiella Pneumoniae. Of note, all three patients with positive cultures also had instrumentation with either an external ventricular drain or a lumbar drain.
Conclusion: Obtaining CSF cultures in TBI patients without instrumentation is of extremely low yield. Other sources of infectious etiologies should be considered in this patient population.