Healthcare-associated ventriculitis and meningitis affect the central nervous system and
can lead to death and permanent disability if not recognized and managed
appropriately. A team approach is vital to 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.
This is among the
recommendations in the first comprehensive guidelines on
healthcare-associated ventriculitis and meningitis, which are being
released by the Infectious Diseases Society of America (IDSA) and
published in the journal Clinical Infectious Diseases
‘Comprehensive guidelines for diagnosis, treatment and prevention of healthcare-associated ventriculitis and meningitis have been issued by the the Infectious Diseases Society of America (IDSA).’
Allan R. Tunkel, lead author of the
guidelines and professor of medicine and associate dean for medical
education at Warren Alpert Medical School of Brown University,
Providence, R.I., said, "While other guidelines have addressed infections in
specific circumstances, these provide more comprehensive guidance to
physicians of various specialties who care for these complex patients."
The guidelines provide parameters regarding when clinicians should
consider the possibility of ventriculitis (inflammation of the
ventricles in the brain) or meningitis (inflammation of the lining of
the brain or spinal cord) in patients who have cerebrospinal fluid
shunts and drains (devices placed in the brain to relieve pressure due
to fluid buildup), intrathecal drug pumps (for administration of pain
medicine or other drugs into the spinal canal), deep brain stimulation
hardware (medical devices that provide electrostimulation in the brain
to treat Parkinson's disease or other neurological symptoms) 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 (ID)
specialists, neurologists, neurosurgeons and neurocritical care
specialists, Dr. Tunkel said.
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 (a
common cause of these types of infections); 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.
"Specialists must work together to ensure proper management of these
patients, which is critically important to improving outcome," said Dr.
Tunkel. "These guidelines offer currently available evidence for
treating these infections, but physicians need to use individual
judgement based on how patients are responding to therapy."