guidelines recommend a team approach for the successful diagnosis and treatment
of complex neurological infections related to placement of devices in the
brain, or as a result of neurosurgery or head trauma. The first comprehensive
guidelines on healthcare-associated ventriculitis and meningitis are now
available in the journal Clinical
guidelines provide parameters regarding when clinicians should consider the
possibility of ventriculitis or meningitis in patients who have cerebrospinal
fluid shunts and drains, intrathecal drug pumps, deep brain stimulation
hardware, or who have undergone neurosurgery or suffered from head trauma. Due
to the complexity of these infections, they need to be managed by a
multidisciplinary team most often featuring infectious diseases specialists,
neurologists, neurosurgeons and neurocritical care specialists.
guidelines help clinicians determine when to suspect ventriculitis or
meningitis and start patients on appropriate antimicrobial therapy while
awaiting culture results to confirm the infection and organism causing it.
Vancomycin typically is the recommended antimicrobial agent of choice while
clinicians await culture results due to its success at combating the
staphylococcus bacteria; another antimicrobial agent is also added to treat
other potential organisms. Additionally, the guidelines recommend when a device
should be removed and replaced.
also delve into various ways these infections may be prevented, such as using
prophylactic antibiotics during placement of the devices, as well as employing
“practice bundles,” specific steps neurosurgeons should take when placing
shunts and drains.
to lead author, Allan R. Tunkel, MD, PhD, the guidelines panel includes: Adarsh
Bhimraj, MD, FIDSA; Thomas P. Bleck, MD, FIDSA; Karin Byers, MD; Hugh J.L.
Garton, MD; Rodrigo Hasbun, MD, FIDSA; Sheldon L. Kaplan, MD, FIDSA; W. Michael
Scheld, MD, FIDSA; Diederik van de Beek, MD, Phd; and Joseph R. Zunt, MD, MPH.
The panel represents pediatric and adult ID specialists, those who specialize
in neurosurgery, neurology, neurocritical care and infection prevention and, in
addition to IDSA, organizations whose members care for these patients,
including the American Academy of Neurology (AAN), American Association of
Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS),
Neurocritical Care Society (NCS) and the Society for Healthcare Epidemiology of
America (SHEA). The guidelines were endorsed by the NCS and SHEA, and their
value and educational content affirmed by AAN, AANS, and CNS.
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