A previously healthy 6-year-old boy was playing with a BB gun he received for his birthday and was accidentally shot in the left temple. His mother immediately cleaned the barely visible wound; however, within a few hours, the boy began to feel unwell and had several episodes of emesis. In the emergency department, a computed tomography scan revealed that the BB was lodged in the parenchyma of the left parietal region, and a small subdural hematoma had formed. He underwent immediate neurosurgery to evacuate the hematoma, but the BB could not be safely removed. He received perioperative cefazolin and tolerated the initial surgery well. Postoperatively, the infectious diseases service was consulted with the question of the necessity for further antibiotics. The consulting physician noted that this question had no definitive answer in the literature because no relevant randomized controlled trials exist. He referred to retrospective and observational prospective studies but felt that data on infection with a retained foreign body were sparse. Given the uncertainty and the potential for a brain abscess or meningitis, the consultant rendered the opinion that the benefits of a long course of broad-spectrum antibiotics outweighed the risks. He ultimately recommended intravenous vancomycin and meropenem for a minimum of 6 weeks. A peripherally inserted central catheter (PICC) was placed on hospital day 5, and the patient was discharged from the hospital with plans to follow up in the infectious disease clinic for weekly laboratory evaluations to monitor for infection or antibiotic adverse effects. Six days after discharge, the patient was readmitted for high fever and loose stools.
Language: en
LA - en SN - 2154-1663 UR - http://dx.doi.org/10.1542/hpeds.2014-0063 ID - ref1 ER -