Genesis of Antibiotic Resistance (AR) XXXIX: Universal Implementation of Simplified Acute Physiology Score (SAPS‐II) score inclusive of AR as an effective prognostic indicator of mortality in Traumatic Brain Injury (TBI) induced Coma

Abstract

Based on an appraisal of the criteria required for deriving the SAPS‐II scores reinforced by statistical significance, a rationale is presented to include factors determining AR, thus enable the clinical decision making to withdraw life support in TBI subsequent to coma (Glasgow Coma Scale (GCS) ranging from a Severe: GCS 3–8; Moderate: GCS 9–12; Mild: GCS 13–15). The SAPS‐II is a severity score and mortality estimation tool developed from a large sample of medical and surgical patients in North America and Europe. The SAPS II includes 17 variables of which 12 physiological variables, age, types of admission (scheduled surgical, unscheduled surgical, or medical), and three underlying disease variables (acquired immunodeficiency syndrome, metastatic cancer, and hematologic malignancy). Within the first 24 hours of admission to Intensive Care Unit (ICU), following factors which determine AR, are suggested to be included: a. performing a culture and sensitivity lab test on the patient's Cerebrospinal fluid (CSF), b. generating an Antibiograms (Antimicrobial Susceptibilities of Selected Pathogens), c. implementation of antibiotics timeout (ATO), and also d. performing antibiotic prophylaxis in case of surgical intervention in TBI is essential for an acceptable neurological outcome. In the event of using the External ventricular device (EVD) for monitoring intracranial pressure (ICP), it is pivotal to monitor the infection of central nervous system (CNS). Acinetobacter baumannii is a known risk factor as a nosocomial infectious agent and associated with high mortality ranging from 15% to 71%. (J Neurosci Rural Pract 2016;7:450–2). Data shows that continuation of antibiotic therapy in TBI with scheduled surgical, or unscheduled surgical cases, are determined based on the detection of AR pathogens causing sepsis. If the patient had antibiotic resistance pathogen including (Colistin resistance) septicemia (Sepsis (Blood Infection) and Septic Shock (J. Neurotrauma 2007;24 Suppl 1: S45–54; Lancet Infect Dis 2009;9:245–55; Infection 2014;42:801–9) a poor neurological outcome is likely. Colistimethate sodium (CMS) as primary or salvage therapy for multi‐drug resistant (MDR) Gram‐negative organisms are known to cause nephrotoxicity, and neurotoxicity in critically ill patients (Ann Intensive Care. 2011; 1:14). Detection of Colistin resistant pathogens in a TBI patient is a reflection of impending septicemia, nephrotoxicity and/or renal failure (associated with poor neurological outcome. Though renal failure depends on the total cumulative dose and duration of Colistin therapy, the severity of TBI, factors such as AR, age, are at a higher risk for nephrotoxicity, possibly a higher rate of mortality. In essence, it is suggested that inclusion of factors causing AR, and SAPS‐II scores ranging from 77 to >80 points would be a determining factor in the clinical decision to withdraw life support in TBI patients in ICU by forestalling an irreversible coma. In the event of the patient (TBI) with Moderate: GCS 9–12; to Mild: GCS 13–15, measures to mitigate AR would plausibly increase acceptable neurological outcome with a possibility of recovery (Lancet.1974 Jul 13; 2(7872):81–4); J Trauma Acute Care Surg. 2015 Oct; 79(4 Suppl 2): S197–203Support or Funding InformationSupported by the Professional Development Funds by SWTJC to Subburaj Kannan.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.