Critically ill patients admitted for acute brain injury are exposed to many heath-care associated infections such as ventilator associated pneumoniae (VAP). The PROHYVAP study, published in 2024 reported that a single dose of CEFTRIAXONE as an antibiotic prophylaxis could reduce the incidence of early VAP (VAP that occured between day 2 and day 7 of mechanical ventilation).

However, patients with acute brain injury also presented frequently augmented renal clearance (ARC), which could affect the pharmacokinetic and pharmacodynamic target attainment (PK/PD) of antibiotic prophylaxis.

This study aims to analyse the PK/PD target attainment after one dose of CEFTRIAXONE in critically ill patients with acute brain injury and to describe the effect of ARC on PK/PD target attainment during early VAP.

Inclusion Criteria:

• 18 years or older
• Admitted in intensive care unit for acute brain injury, including traumatic brain injury and cerebral vascular disease
• Glasgow coma scale inferior to 12
• Orotracheal intubation in first 12 hours of admission
• Needed of invasive mechanical ventilation for at least 48 hours

Exclusion Criteria:

• Acute brain injury related to tumoral or infectious process
• Antibiotic therapy administered before acute brain injury for an other pathology
• Patients with a risk of multiresistance bacteria contamination (stay in a risk area in the past 3 months, antibiotic therapy with fluoroquinolone or betalctamine in the past 3 months, hospitalization in last month before admission, documented contaminationwith multiresistance bacteria, immunodepression)
• Patients with hish risk of death in the first 48 hours
• Patients with a beta-lactams reported allergy

Patients admitted in intensive care unit for an acute brain injury caused by a traumatic brain injury or a vascular cerebral disease (ischemic stroke, subarachnoid hemorrhage, intracerebral hemorrhage) with a Glasgow coma scale < 12 and needed a mechanical ventilation for 48 hours or more, started in the first 12 hours.