![]() 1 CSF may also be assessed for white blood cell count, glucose, protein, lactate, and biomarkers such as procalcitonin. 1,2,5 CSF cultures should be held for at least 10 days (to allow for detection of slower-growing microorganisms such as C acnes) for suspected CSF shunt or drain infections in those with initial negative cultures. 1,2,5 CSF fluid should be collected if healthcare-associated ventriculitis and meningitis is suspected in order to establish the diagnosis of infection. Signs and symptoms of healthcare-associated ventriculitis and meningitis may vary and include new headache, fever, nausea, lethargy, new or worsening altered mental status, seizures, erythema, tenderness or drainage at a surgical site, and/or peritonitis/abdominal tenderness in those with ventriculoperitoneal shunts. 1,2,4,5,8 It may also be difficult to distinguish symptoms of infection from the presence of an underlying neurologic disease or condition. 2,5,7 Additionally, the clinical presentation of infection may vary based on the infecting pathogen (coagulase-negative staphylococci and C acnes are more indolent pathogens that may cause less meningeal inflammation and associated symptoms) source of infection (a device-related infection may present with a surgical wound infection with or without meningitis symptoms) and the patient’s age (altered mental status may be more common in those aged ≥65 years). 1,2,4,5 Although CSF Gram stain and culture are important for diagnosis, initiation of antimicrobial therapy prior to collection of CSF impacts the sensitivity of these tests and can result in false-negative results. The diagnosis of healthcare-associated ventriculitis and meningitis is challenging for many reasons. 1 In terms of fungal etiology, Candida species most commonly cause infection in the post-operative setting, while Candida spp., Aspergillus spp., and Cryptococcus neoformans have been found to cause infection in patients with traumatic head injuries. 1,6 Fungal pathogens are much less common than bacteria. The most common bacterial etiologies of healthcare-associated ventriculitis and meningitis are Staphylococcus aureus, coagulase-negative staphylococci (such as Staphylococcus epidermidis), Cutibacterium acnes (formerly named Propionibacterium acnes) and Gram-negative bacilli, including Escherichia coli, Enterobacter spp., Citrobacter spp., Serratia spp., and Pseudomonas aeruginosa. 2-5 This article reviews the etiology, diagnostic considerations, and management of healthcare-associated bacterial ventriculitis and meningitis, including information from the Infectious Diseases Society of America (IDSA) guidelines. 1,2,4,5 It is important for pharmacists to know the appropriate management of these serious infections, which are associated with significant neurologic morbidity and mortality, including moderate-to-severe disability, persistent vegetative state, or death. 3 Healthcare-associated ventriculitis and meningitis are considered to be diagnostic challenges. 1,2 In terms of devices, CSF shunts or drains are the most common causes of infection. H ealthcare-associated ventriculitis and meningitis refers to an infection that results from an invasive procedure related to the placement of a device (such as a cerebrospinal fluid shunt, CSF drain, intrathecal infusion pump, or deep brain stimulation hardware) or as a complication related to neurosurgery or head trauma. Pharmacists are in a key position to understand the diagnostic challenges and recommend appropriate empiric and directed antimicrobial treatment for the management of these infections. Therapy should be modified and directed toward the identified pathogen, with a typical treatment duration of 10 to 14 days. ![]() According to guidelines released by the Infectious Diseases Society of America, the recommended empiric antimicrobial treatment for these types of infections is vancomycin in combination with an antipseudomonal beta-lactam-either cefepime, ceftazidime, or meropenem. ABSTRACT: Healthcare-associated ventriculitis and meningitis is a serious infection that most commonly has a bacterial etiology, including Gram-positive and Gram-negative microorganisms. ![]()
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