Neurosurg Rev. 2026 Feb 18;49(1):232. doi: 10.1007/s10143-026-04139-7.
ABSTRACT
Penetrating traumatic brain injury (pTBI) is a severe subset of cranial trauma associated with high mortality and a substantial burden of intracranial infections. The pTBI infection rates have decreased from approximately 60% in the pre-war era to about 10% today, due to improvements in operative debridement, critical care, and widespread antibiotic availability; however, the independent effect of prophylactic antibiotics remains uncertain, and clinical practice is highly variable. This systematic review and meta-analysis aims to determine whether prophylactic antibiotics truly reduce intracranial infections in pTBI patients. A systematic review and meta-analysis were conducted following PRISMA guidelines. The PubMed, Scopus, and LILACS were rigorously searched. The primary effectiveness outcome analyzed was the risk of central nervous system infection. Secondary outcomes included antibiotic regimens and duration, mortality, and functional outcomes were assessed. Data were analyzed using a random-effects meta-analysis, and statistical heterogeneity was assessed. The study was registered with PROSPERO (CRD420251033854). Eight studies comprising 1372 patients (891 received antibiotic prophylaxis and 481 did not) were included. We found that the administration of prophylactic antibiotics did not significantly reduce the risk of suffering an intracranial infection OR 1.10 (95% CI 0.29-4.22 I2 = 48.8%). Furthermore, there was no statistically significant difference between monotherapy and multiple antibiotics, or shorter versus longer courses. Moreover, only one study employed a standardized antibiotic regimen. Prophylactic antibiotic administration in patients with penetrating traumatic brain injury was not associated with a statistically significant reduction in the risk of intracranial infections, as evidenced by substantial heterogeneity in the available literature. However, if prophylaxis is administered, it should be a short-course, monotherapy regimen. These findings highlight the urgent need for high-quality, standardized clinical trials to establish evidence-based guidelines for the use of prophylactic antibiotics in this high-risk population.
PMID:41706320 | DOI:10.1007/s10143-026-04139-7
