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    The selection of the patients was based on the following criteria: the reason for admission to the ICU was head injury (70 patients) or cerebral hemorrhage (48 patients); all patients had undergone a neurosurgical procedure; and an infection occurred during hospitalization in the ICU. Methods All patients out of the 118 that presented fever or laboratory findings of an infection which could not be attributed to an infection of any other reason except CNS underwent lumbar puncture. Results Twenty-seven patients underwent lumbar puncture (22.88 ). Findings from the lumbar puncture compatible with an infection of the CNS occurred in six patients (five patients with cerebral injury and one patient with cerebral hemorrhage) out of 118 patients, 5.08 of all patients (7.14 of head injury and 2.08 of cerebral hemorrhages). The days that the lumbar puncture was performed were the 4th?9th postoperative days. The mean GCS value during the admittance to the hospital of the total patients was 8.88 (3?5), but the mean GCS value of those patients that developed CNS infection was 7.86 (3?4). Conclusions The administration of Healthcare costs and specially to those infections because of multidrug resistance antibiotics from the first day of admittance to the ICU probably is accountable for the very low rate of infection of the CNS in patients with head injury or cerebral hemorrhage. There is no important difference between the scheduled surgical procedure from the head injury and automatic cerebral hemorrhage. Further studies are needed for the reduction and control of the postoperative infections in these patients. References 1. Korinek AM: Neurosurgery 1997, 41:1073-1079. 2. Korinek AM, Golmard JL, Elcheick A, et al.: Br J Neurosurgery 2005, 19:155-162. 3. Kourbeti IS, Jacobs AV, Koslow M, et al.: Neurosurgery 2007, 60:317-325.cultures were obtained in 96 (94 ) patients, only 8 were positive versus 39 in nonrespiratory CAS (P < 0.001). Grampositive microorganisms represented 51 of all isolations, Gramnegative 26 , Mycobacterium tuberculosis 6 , atypical 5 , and fungus represented only 2 of all isolations. Polymicrobian infections were documented in 5 of the patients. HCR respiratory infection was present in 17 . Gram-positive microorganisms represented 50 of all isolations, and Gram-negative 37 . ICU length of stay (9 vs 8 days, P = 0.595), as well as ICU (35 vs 32 , P = 0.686) and hospital (36 vs 41 , P = 0.559) mortality were similar between respiratory and non-respiratory CAS. Conclusions Respiratory CAS is a very important problem in the ICU, representing 30 of all admissions. Although the microbiological profile is similar to that described in the literature, in this population tuberculosis still plays a representative role and needs to be considered. In this population, no significant differences in the microbiological profile were seen between CAS and HCR infection. Reference 1. Friedman ND, Kaye KS, Stout JE, et al.: Health care-associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med 2002, 137:791-797.P15 Antibiotic costs in bacteremic and nonbacteremic patients treated with the de-escalation approachE Evodia1, P Myrianthefs1, P Prezerakos2, G Baltopoulos1 1KAT General Hospital, Athens, Greece; 2Municipality of Athens, Educational Centre, Athens, Greece Critical Care 2008, 12(Suppl 2):P15 (doi: 10.1186/cc6236) Introduction Antibiotic therapy significantly contributes to.