Causes of infections in penetrating head wounds in the Iran-Iraq War.

Factors seemingly influential in postoperative central nervous system infections were evaluated in 379 patients who sustained missile wounds to the head during the Iran-Iraq War. The mean wound age was 49 hours. The site of injury and presence of retained bone and/or shell fragments did not have a significant effect on infection rate. Thirty-three of 379 patients developed cerebrospinal fluid (CSF) fistulas of which 12 (36%) were associated with infection. The infection rate was 6 of 346 (1.7%) in the absence of CSF leaks. There was a statistically significant association between CSF fistula and infection. All 6 positive cultures in patients with CSF fistulas were gram-negative. Thirty-two patients died during the study, a mortality rate of 8.4%. The mortality rate from infection was 1.8%. Two hundred seventy-seven of 347 patients were followed for a mean of 22 +/- 17 months during which time 2 patients were readmitted with central nervous system infections, both due to CSF leakage. CSF fistulas were the main predisposing factor in postdebridement central nervous system infections in this study.