Healthcare-associated central nervous system infections

Abstract

Purpose of reviewThe aim of this review is to provide a practical and updated summary on healthcare-associated central nervous system infections and their management. Recent findingsThe term 'healthcare-associated ventriculitis and meningitis' has recently been coined and clinical practical guidelines have been published on the management of these nosocomial infections. Many aspects have still to be further investigated (e.g. cerebrospinal fluid biomarkers, indications for novel antibiotics, intrathecal antimicrobial regimens). SummaryClinicians should maintain a high index of suspicion for healthcare-associated central nervous system infections in patients with specific risk factors (i.e. recent neurosurgery, cerebrospinal shunts, drains or implantable devices, head/spinal traumatic events), taking into account systemic signs, and alterations in microbiological, imaging, cerebrospinal fluid findings. The diagnosis is often difficult to confirm because of reduced levels of consciousness or coma. Both Gram-positive and Gram-negative (often multidrug-resistant or even pandrug-resistant) microorganisms may be the cause. Selection of antibiotics must consider susceptibility and penetration into the central nervous system. Ineffective treatments are frequent, and mortality can reach 60%. Future research should focus on the diagnostic performance of biomarkers and on the use of novel antimicrobial regimens, especially for the treatment of difficult to treat infections.

Empirical cefepime+vancomycin versus ceftazidime+vancomycin versus meropenem+vancomycin in the treatment of healthcare-associated meningitis: results of the multicenter Ephesus study

“…The HCAM guidelines recommend ceftazidime, cefepime, or meropenem + vancomycin as empirical therapy options [ 5 ]. Although these combinations are the most commonly suggested regimens [ 1 , 2 , 4 , 5 ], there has been no controlled or uncontrolled comparative analysis to determine the efficacy of these options. Cefepime has an advantage over ceftazidime in that it is resistant to inducible Ampc type beta-lactamases, while ceftazidime and cefepime both have the disadvantage of being susceptible to most ESBLs compared to meropenem.…”

“…This difference also results in a discrepancy in empirical antibiotic therapy. While the third-generation cephalosporin ± ampicillin and vancomycin or rifampin is recommended for empirical CAM therapy, HCAM empirical treatment is recommended to be a combination of vancomycin with ceftazidime or cefepime or meropenem [ 1 , 2 , 5 , 7 ]. However, to our knowledge, there are no published clinical data comparing these empirical treatment regimens in terms of efficacy in HCAM.…”

Palliative Care and End-of-Life Issues in Patients with Brain Cancer Admitted to ICU

“…However, the prognosis of patients affected by such tumors remains poor, with a mean overall survival of about one year from first diagnosis (i.e., 14–15 months). Additionally, comorbid and frail patients may experience an even worse course [ 2 ], with difficult hospital stay, sometimes requiring postsurgical intensive care unit (ICU) admission. Peculiar management is expected for patients with anticipated poor prognosis, as aggressive therapeutical approaches would not determine a full restoration of organ function, and life expectancy may not be affected by curative care [ 3 ].…”