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IDSA guidelines address health care–associated ventriculitis, meningitis
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The Infectious Diseases Society of America has released new guidelines on detecting and treating ventriculitis and meningitis occurring after invasive procedures.
Espousing a multidisciplinary approach to such infections, a 10-member panel assembled by the IDSA and other groups made recommendations on managing them. The group also provided guidelines for identifying and treating infections associated with head trauma, general surgery and procedures implanting cerebrospinal fluid shunts, cerebrospinal fluid drains, intrathecal infusion pumps and deep brain stimulation hardware.
“These complicated infections affect the central nervous system and can lead to death or permanent disability if not recognized and managed appropriately,” panel member Allan R. Tunkel, MD, PhD, associate dean for medical education at the Warren Alpert Medical School of Brown University, said in a press release.
“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 panel comprised infectious disease specialists, neurosurgeons and others, and qualified each guideline using two measures — the strength of the recommendation and the quality of evidence supporting it.
The panel warned that ventriculitis and meningitis can occur after patients leave the hospital “or even many years later.” In addition, diagnosis is not always easy.
“These infections may be difficult to diagnose because changes in cerebrospinal fluid parameters are often subtle, making it hard to determine if the abnormalities are related to infection, related to placement of devices or following neurosurgery,” the panel wrote.
The panel described symptoms associated with infections following each procedure, as well as certain tests of cerebrospinal fluids to confirm infection, which antimicrobial agents should be used in which circumstances and how patients’ response to treatment should be monitored, among others.
They also included recommendations for preventing infection during surgery, including antibiotics, surgical measures and others. The panel stressed cooperation among physicians treating patients.
“Specialists must work together to ensure proper management of these patients, which is critically important to improving outcome,” Tunkel said in the press release.
“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.” — by Joe Green
Disclosure: Tunkel reports receiving royalties from UpToDate and Elsevier and honoraria from ACP and Merck. Please see the full guidelines for a list of all other authors’ relevant financial disclosures.
Perspective
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Rodrigo Hasbun, MD, MPH
Health care–associated ventriculitis and meningitis can occur in association with central nervous system devices (ie, cerebrospinal shunts or drains, intrathecal pumps and deep brain stimulators) after neurosurgical procedures such as craniotomies, epidural injections or spinal surgeries and after head trauma, and are associated with substantial morbidity and mortality in the majority of patients.
Diagnosing and treating these infections represents a challenge to physicians because cerebrospinal fluid cultures may be negative due to previous antibiotic therapy, and cerebrospinal abnormalities may be secondary to the primary neurosurgical issue (eg, “chemical meningitis” due to intracranial hemorrhage).
The 2017 IDSA health care–associated ventriculitis and meningitis guidelines are the first comprehensive review of the current available literature to help guide clinicians in the management of this challenging syndrome with high mortality and morbidity. All other meningitis guidelines in the past have focused only on community-acquired bacterial meningitis.
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