***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — Fever after stroke is a strong predictor for a negative outcome with infections as the most common cause . The aim of this pilot study was to evaluate the effects of prophylactic antibiotic therapy on the incidence and height of fever after acute ischemic stroke . Methods — This is a r and omized , controlled study of antibiotic prophylaxis in patients with ischemic stroke enrolled within 24 hours from clinical onset who presented bedridden ( modified Rankin score > 3 ) with no significant infection . Interventions included prophylactic mezlocillin plus sulbactam ( 3 × 2 g/1 g for 4 days ) or conventional management . Over 10 days , body temperature was continuously monitored , and the presence of infection was daily assessed . Primary end points were incidence and height of fever ; secondary end points included rate of infection and clinical outcome . Results — Sixty patients were included ( mean , 75 years ; median National Institutes of Health Stroke Scale score , 16 ) . Over the first 3 days , patients in the intervention group showed lower mean body temperatures as well as lower daily peak temperatures ( P<0.05 ) . Throughout the observation period , 15 of 30 patients in the intervention group but 27 of 30 patients in the conventionally treated group developed an infection ( P<0.05 ) . Mean interval until the diagnosis of infection was 5.1 days in the intervention group and 3.3 days in the control group ( P<0.05 ) . Clinical outcome was more favorable in patients with prophylactic therapy ( P=0.01 ) . Conclusions — In patients with acute severe stroke , prophylactic administration of mezlocillin plus sulbactam over 4 days decreases body temperature , lowers the rate of infection , and may be associated with a better clinical outcome OBJECT An important complication of external CSF drainage is bacterial meningitis or ventriculitis , result ing in increased morbidity , mortality , and health care costs . In 2003 , a high rate ( 37 % ) of probable drain-related infections was identified at the authors ' hospital . A multidisciplinary working group was installed to reduce this incidence to < 10 % within 1.5 years . METHODS An intervention strategy based on 5 pillars ( increased awareness , focused st and ard operating procedures , a diagnostic and therapeutic algorithm , timely administration of prophylaxis , and improvement of the drainage system ) was design ed and implemented from 2004 to 2006 . During this period all patients with external CSF drainage  were prospect ively monitored . RESULTS Between 2004 and 2006 , there were 467 patients in whom 579 drains ( external ventricular and external lumbar ) had been placed . The overall incidence of drain-related infections was 16.2 % in 2004 , 8.9 % in 2005 , and 11.3 % in 2006 . For external lumbar drains the number of infections per 100 drain days was 2.4 in 2004 , 0.6 in 2005 , and 0.8 in 2006 . For external ventricular drains these rates were 1.7 , 1.0 , and 1.2 , respectively . Meanwhile , the causative noncutaneous microorganisms , indicative for systemic-contamination during manipulation , decreased . By retrospective analysis , the proportion of patients with a probable drain-related infection decreased from 37 % in 2003 to 9 % in 2005 and 2006 . CONCLUSIONS The authors ' multidisciplinary approach in which different preventive measures were combined was associated with a significant reduction in the incidence of drain-related secondary meningitis , and thus provides an important improvement of patient safety BACKGROUND Ventilator-associated pneumonia ( VAP ) is an important cause of morbidity and mortality in ventilated critically ill patients . PURPOSE To develop evidence -based guidelines for the prevention of VAP . DATA SOURCES MEDLINE , EMBASE , CINAHL , and the Cochrane Data base of Systematic Review s and Register of Controlled Trials . STUDY SELECTION The authors systematic ally search ed for all relevant r and omized , controlled trials and systematic review s on the topic of prevention of VAP in adults that were published from 1980 to October 1 , 2006 . DATA EXTRACTION Independently and in duplicate , the panel scored the internal validity of each trial . Effect size , confidence intervals , and homogeneity of the results were scored using predefined definitions . Scores for the safety , feasibility , and economic issues were assigned based on consensus of the guideline panel . LEVELS OF EVIDENCE The following statements were used : recommend , consider , do not recommend , and no recommendation due to insufficient or conflicting evidence . DATA SYNTHESIS To prevent VAP : We recommend : that the orotracheal route of intubation should be used for intubation ; a new ventilator circuit for each patient ; circuit changes if the circuit becomes soiled or damaged , but no scheduled changes ; change of heat and moisture exchangers every 5 to 7 days or as clinical ly indicated ; the use of a closed endotracheal suctioning system changed for each patient and as clinical ly indicated ; subglottic secretion drainage in patients expected to be mechanically ventilated for more than 72 hours ; head of bed elevation to 45 degrees ( when impossible , as near to 45 degrees as possible should be considered ) . Consider : the use of rotating beds ; oral antiseptic rinses . We do not recommend : use of bacterial filters ; the use of iseganan We make no recommendations regarding : the use of a systematic search for sinusitis ; type of airway humidification ; timing of tracheostomy ; prone positioning ; aerosolized antibiotics ; intranasal mupirocin ; topical and /or intravenous antibiotics .  CONCLUSION There are a growing number of evidence -based strategies for VAP prevention , which , if applied in practice , may reduce the incidence of this serious nosocomial infection A controlled double-blind study was performed on patients with injury to the head and face which had caused rhinorrhea or otorrhea . The patients were treated , at the time of the admission to the hospital , with penicillin ( 20 mega-units daily ) or a placebo .  A total of 52 patients was studied , 26 in each treatment group .  Meningitis developed in one patient in the placebo group . Staphylococcus epidermidis ( sensitive to penicillin ) was the causative pathogen in this patient who also had a retained intraventricular foreign body . The frequency of extra-neurological infections and of asymptomatic pulmonary bacterial colonization was similar in both groups , but frequency of asymptomatic bacteriuria was higher in the placebo-treated patients OBJECT The purpose of this study was to compare the efficacy of the prophylactic use of ceftriaxone for the prevention of meningitis in patients with acute traumatic pneumocephalus . METHODS In this prospect i ve , single-institution , r and omized clinical trial , 109 patients with mild head injury and traumatic pneumocephalus were r and omly assigned to receive or not receive an antibiotic medication ( ceftriaxone , 1 g given twice a day ) until occurrence of meningitis or at least 5 days after trauma . The patients were followed up for 1 month posttrauma . The 109 patients were divided into two groups : 53 were assigned to the prophylactic antibiotics therapy group and 56 to the control group . The overall rate of meningitis was 20.1 % and the rates of meningitis in the two groups were not significantly different . The results were the same when adjusted for the patient 's Glasgow Coma Scale score , sex , and age , as well as for an intradural location of air , air volume , presence of cerebrospinal fluid ( CSF ) rhinorrhea or CSF otorrhea , radiological sign of a skull base fracture , or intracranial hemorrhage . CONCLUSIONS The results of this study do not substantiate the efficacy of ceftriaxone used in the prevention of meningitis in patients with traumatic pneumocephalus after mild head injury or in any specific subgroup of these patients . Cerebrospinal fluid rhinorrhea and intracranial hemorrhage may be considered primary risk factors for the development of meningitis in patients with posttraumatic pneumocephalus and , in the absence of these symptoms , intradural location of air and air volume greater than 10 ml may be considered secondary risk factors . Further studies in this area are warranted BACKGROUND The overall benefits of craniectomy must include procedural risks from cranioplasty . Cranioplasty carries a high risk of surgical site infections ( SSI ) particularly with antibiotic resistant bacteria . The goal of this study was to measure the effect of a cranioplasty bundle on peri-operative complications . METHODS The authors queried a prospect i ve , inpatient neurosurgery data base at Kaiser Sacramento Medical Center for craniectomy and cranioplasty over a 7 year period . 57 patients who underwent cranioplasties were identified . A retrospective chart review was completed for complications , including surgical complications such as SSI , wound dehiscence , and re-do cranioplasty . We measured cranioplasty complication rates before and after implementation of a peri-operative bundle , which consisted of peri-operative vancomycin ( 4 doses ) , a barrier dressing through post-operative day ( POD ) 3 , and de-colonization of the surgical incision using topical chlorhexidine from POD 4 to 7 . RESULTS The rate of MRSA colonization in cranioplasty patients is three times higher than the average seen on ICU admission screening ( 19 % vs. 6 % ) . The cranioplasty surgical complication rate was 22.8 % and SSI rate was 10.5 % . The concurrent SSI rate for craniectomy was 1.9 % . Organisms isolated were methicillin-resistant Staphylococcus aureus ( 4 ) , methicillin-sensitive S. aureus ( 1 ) , Propionibacterium acnes ( 1 ) , and Escherichia coli ( 1 ) . Factors associated with SSI were peri-operative vancomycin ( 68.6 % vs. 16.7 % , p=0.0217 ) . Complication rates without ( n=21 ) and with ( n=36 ) the bundle were : SSI ( 23.8 % vs. 2.8 % , p=0.0217 ) and redo cranioplasty ( 19 % vs. 0 % , p=0.0152 ) . Bundle use did not affect rates for superficial wound dehiscence , seizures , or hydrocephalus . CONCLUSIONS The cranioplasty bundle was associated with reduced SSI rates and the need for re-do cranioplasties Background Pneumonia is a major risk factor of death after acute stroke . In a mouse model , preventive antibacterial therapy with moxifloxacin not only prevents the development of post-stroke infections , it also reduces mortality , and improves neurological outcome significantly . In this study we investigate whether this approach is effective in stroke patients . Methods Preventive ANtibacterial THERapy in acute Ischemic Stroke ( PANTHERIS ) is a r and omized , double-blind , placebo-controlled trial in 80 patients with severe , non-lacunar , ischemic stroke ( NIHSS>11 ) in the middle cerebral artery ( MCA ) territory . Patients received either intravenous moxifloxacin ( 400 mg daily ) or placebo for 5 days starting within 36 hours after stroke onset . Primary endpoint was infection within 11 days . Secondary endpoints included neurological outcome , survival , development of stroke-induced immunodepression , and induction of bacterial resistance . Findings On intention-to treat analysis ( 79 patients ) , the infection rate at day 11 in the moxifloxacin treated group was 15.4 % compared to 32.5 % in the placebo treated group ( p = 0.114 ) . On per protocol analysis ( n = 66 ) , moxifloxacin significantly reduced infection rate from 41.9 % to 17.1 % ( p = 0.032 ) . Stroke associated infections were associated with a lower survival rate . In this study , neurological outcome and survival were not significantly influenced by treatment with moxifloxacin . Frequency of fluoroquinolone resistance in both treatment groups did not differ . On logistic regression analysis , treatment arm as well as the interaction between treatment arm and monocytic HLA-DR expression ( a marker for immunodepression ) at day 1 after stroke onset was independently and highly predictive for post-stroke infections . Interpretation PANTHERIS suggests that preventive administration of moxifloxacin is superior in reducing infections after severe non-lacunar ischemic stroke compared to placebo . In addition , the results emphasize the pivotal role of immunodepression in developing post-stroke infections . Trial Registration Controlled-Trials.com IS RCT BACKGROUND : External ventricular drains ( EVDs ) are valuable adjuncts in the management of neurosurgical patients but are associated with a significant risk of cerebrospinal fluid ( CSF ) infection ( range , 0 % to 27 % ) ; a review of 23 studies reported a mean of 8.8 % . OBJECTIVE : To compare the efficacy of 2 different antibiotic-impregnated EVD catheters in preventing CSF infections . METHODS : Patients were prospect ively enrolled in an Institutional Review Board – approved study . During altern 
    Output:
    
The review ed literature highlights the need for collaborative , multi-disciplinary , and multi-pronged approaches to reduce infections .