Among critically ill patients with acute brain injury, prophylactic IV antibiotics were associated with less VAP but not with changes in length of stay, mortality, or neurologic outcomes.

Patients with structural brain injuries may benefit more than those with hypoxic brain injury but further studies are needed to confirm or refute this possibility.

We identified seven eligible trials (827 patients). Prophylactic antibiotics were associated with less VAP but not with changes in duration of mechanical ventilation, ICU length of stay, hospital mortality, or long-term neurologic outcomes.

On stratification by mechanism of injury, antibiotic prophylaxis was associated with significantly less VAP, shorter ICU length of stay, and a trend toward lower mortality in patients with structural but not hypoxic brain injuries.

Other sensitivity analyses were consistent with the primary findings.

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