Archive for April 1, 2019

Management of post-neurosurgical meningitis: narrative review.

Clinical Microbiology and Infection September 2017 V.23 N.9 P.621-628.

Hussein K1, Bitterman R2, Shofty B3, Paul M1, Neuberger A4.

Abstract

BACKGROUND:

Infections complicating neurosurgery pose unacceptable mortality and morbidity.

AIMS:

To summarize what is known about the epidemiology, diagnosis and treatment of post-neurosurgical meningitis (PNM).

SOURCES:

PubMed, references of identified studies and reviews, and personal experience when evidence was lacking.

CONTENT:

The incidence and pathogen distribution of PNM is highly variable. A shift towards Gram-negative bacteria has been observed with use of antibiotic prophylaxis and antibiotic-coated devices directed mainly against Gram-positive bacteria. However, knowledge of the local epidemiology is necessary to treat PNM. The diagnosis of PNM is difficult because, unlike community-acquired meningitis, symptoms are less specific; patients are ill at baseline and many neurosurgical conditions mimic meningitis and cause cerebrospinal fluid (CSF) abnormalities. Pivotal CSF findings for diagnosis of PNM are the CSF glucose, CSF lactate and Gram stain. CSF leucocyte counts are not specific in PNM. Current diagnostic capabilities leave a non-negligible category of patients with microbiologically negative, uncertain diagnosis of PNM. There is no high-quality evidence on several cardinal issues in PNM management, including the effectiveness of intraventricular or intrathecal (IV/IT) antibiotics, effectiveness of dual antibiotic therapy for multidrug-resistant Gram-negative bacteria; clinical benefit of routine therapeutic drug monitoring; and safest timing of shunt replacement. Some data point to a potential benefit of IV/IT antibiotic treatment, mainly for PNM caused by carbapenem-resistant Gram-negative bacteria. Carbapenem-colistin combination therapy is suggested for PNM caused by carbapenem-resistant Gram-negative bacteria with a carbapenem MIC ≤8 mg/L.

IMPLICATIONS:

Guiding the optimal management of PNM will necessitate collaborative multicentre efforts and unique study designs.

FULL TEXT

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(17)30273-2/fulltext

PDF

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(17)30273-2/pdf

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April 1, 2019 at 6:34 pm

Intrathecal and intraventricular antibiotics for postoperative Gram-negative meningitis and ventriculitis.

Surg Neurol Int. september 2017 V.8 P.226.

Khan SA1, Waqas M2, Siddiqui UT2, Shamim MS2, Nathani KR2, Jooma R2, Mehmood F3.

Abstract

BACKGROUND:

Postoperative meningitis is a growing cause of concern, especially with the evolution of multidrug-resistant organism. The authors evaluate the use of intraventricular/intrathecal (IVT/IT) antibiotics for postoperative gram-negative meningitis in patients whom intravenous antibiotics were ineffective.

METHODS:

Medical records were retrospectively reviewed and neurosurgery patients with gram-negative postoperative infection meningitis/ventriculitis were enrolled in the study. Their demographics, hospital course, and outcomes were recorded in a pro forma and analyzed using Statistical Package for the Social Sciences, version 19.

RESULTS:

The review identified 21 patients with postneurosurgical gram-negative meningitis/ventriculitis who were treated with IVT or IT antibiotics. The most common organism was Acinetobacter species (n = 14; 66%). Amikacin was used in 7 patients, polymyxin B in 9 patients, and colistin in 5 patients. A combination of antibiotics was used in one patient. Cerebrospinal fluid sterility was achieved in all patients with no incidence of relapse. There was a single death, though that was not related to the infectious process as the patient had a massive pulmonary embolism.

CONCLUSION:

The findings of this study suggest that IVT and IT antibiotic therapy is a useful option in patients who are nonresponsive to standard intravenous therapy with little or no side effects.

FULL TEXT

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5629845/

April 1, 2019 at 6:32 pm


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