What are the guideline sources, guidelines and references for Healthcare-associated ventriculitis and meningitis ?
Guideline sources The following summarized guidelines for the evaluation and management of healthcare-associated ventriculitis and meningitis (HAVM) are prepared by our editorial team based on guidelines from the Infectious Diseases Society of America (IDSA 2017). 1 Guidelines 1. Screening and diagnosis Clinical presentation (patients with CSF shunts): interpret new headache, nausea, lethargy, and/or a change in mental status as suggestive of CSF shunt infection. B Show 2 more Clinical presentation (patients with intrathecal pumps): consider new fever and drainage from the surgical site to be suggestive of wound infection in patients with intrathecal infusion pumps. C Clinical presentation (patients with recent trauma or neurosurgery): in the setting of recent trauma or neurosurgery, new headache, fever, evidence of meningeal irritation, seizures, and/or worsening mental status are suggestive of ventriculitis or meningitis. B Clinical presentation (patients with external ventricular drains): https://web.pathway.md/diseases/recLZPSS31H6qTBn1 1/3 6/24/23, 12:31 PM Healthcare-associated ventriculitis and meningitis Pathway Suspect HAVM in patients with with external ventricular drains who develop new or worsening altered mental status. B Suspect HAVM in patients with with external ventricular drains who develop fever and increased WBC count. B 2. Diagnostic investigations CSF biochemical testing: recognize that abnormalities of CSF cell count, glucose, and/or protein may not be reliable indicators of infection in patients with HAVM. B CSF microbiological testing: avoid excluding CNS infection on the sole basis of a negative CSF Gram stain, especially in patients who have received previous antimicrobial therapy. D CSF cultures: Obtain CSF cultures to establish the diagnosis of HAVM. A Hold cultures for at least 10 days in an attempt to identify organisms such as P. acnes in patients with CSF shunts or drains and negative initial CSF cultures. A Neuroimaging: obtain neuroimaging in patients with suspected HAVM. B 3. Medical management Empiric antibiotic therapy: administer vancomycin plus an anti-pseudomonal -lactam (such as cefepime, ceftazidime, or meropenem) as empiric antibiotic therapy for HAVM. B Interpretation of CSF cultures: diagnose HAVM based on CSF pleocytosis with a positive culture and symptoms of infection. A Show 2 more Intraventricular antimicrobial therapy: consider intraventricular antimicrobial therapy to patients with HAVM in whom the infection responds poorly to systemic antimicrobial therapy alone. B 4. Specific circumstances Patients with Staphylococcus infection: administer nafcillin or oxacillin for treatment of infection caused by MSSA (strong, moderate). If the patient cannot receive -lactam agents, consider desensitizing the patient or prescribing vancomycin as an alternative agent. B Show 4 more Patients with Pseudomonas infection: Administer cefepime, ceftazidime, or meropenem as the recommended therapy to treat infection caused by Pseudomonas species. B Use aztreonam or a fluoroquinolone as alternative agents for isolates with in vitro activity. B Patients with Acinetobacter infection: Administer meropenem to treat infection caused by Acinetobacter species. B https://web.pathway.md/diseases/recLZPSS31H6qTBn1 2/3 6/24/23, 12:31 PM Healthcare-associated ventriculitis and meningitis Pathway Use colistimethate sodium or polymyxin B for strains that demonstrate carbapenem resistance. Either agent is administered by the intravenous and intraventricular routes. B Patients with Gram negative bacilli infection: treat infection caused by Gram-negative bacilli using agents that achieve good CNS penetration, and adjust therapy based on in-vitro susceptibility testing. B Patients with Propionibacterium infection: administer penicillin G for treatment of infection caused by P. acnes. B Patients with fungal infection: Administer liposomal amphotericin B, often combined with 5-flucytosine, to treat HAVM caused by Candida species, based on in vitro susceptibility testing. B Consider switching to fluconazole once the patient shows clinical improvement, if the isolated species is susceptible. C References 1. Tunkel AR, Hasbun R, Bhimraj A et al. 2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis. 2017 Feb 14. Open 2. Chanunya Srihawan, Rodrigo Lopez Castelblanco, Lucrecia Salazar et al. Clinical Characteristics and Predictors of Adverse Outcome in Adult and Pediatric Patients With Healthcare-Associated Ventriculitis and Meningitis. Open Forum Infect Dis. 2016 Apr 13;3 2):ofw077. Open https://web.pathway.md/diseases/recLZPSS31H6qTBn1 3/3