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February 2017
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New IDSA Guideline on Ventriculitis and Meningitis

New IDSA 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 Infectious Diseases.

The 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.

The 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.

The guidelines 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.

In addition 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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