Healthcare-Associated Infections in the Neurocritical Care Unit

Busl, Katharina M.

doi:10.1007/s11910-019-0987-y

Cited by 19 publications

(10 citation statements)

References 114 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While the incidence of community-acquired meningitis with multiresistant pathogens is still relatively low, particularly external and internal ventricular shunt infections and infections of other devices in the CNS with multiresistant bacteria pose a therapeutic challenge. Typical pathogens of nosocomial meningitis and ventriculitis are methicillin-resistant coagulase-negative staphylococci and Staphylococcus aureus, vancomycin-resistant enterococci, and carbapenemase-producing Gram-negative bacteria (Acinetobacter spp., Klebsiella spp., Escherichia coli, and Pseudomonas aeruginosa) (1)(2)(3). Eleven years after the extensive review of intrathecal antibiotic treatment options by Ziai and Lewin (4), 10 years after our review on the pharmacokinetics of antiinfectives in the CNS compartments in this journal (5), and on the background of increasing problems with multiresistant pathogens in nosocomial CNS infections, this review of PubMed-listed publications until January 2020 aims to update the indications, pharmacokinetic principles, and complications of intrathecal antibacterial and antifungal therapy in meningitis and ventriculitis.…”

Section: Introductionmentioning

confidence: 99%

Intrathecal Antibacterial and Antifungal Therapies

2020

View full text Add to dashboard Cite

SUMMARY Intrathecal administration of anti-infectives is indicated in central nervous system infections by multiresistant pathogens when drugs that can reach adequate cerebrospinal fluid (CSF) concentrations by systemic therapy are not available. Antibiotics that readily pass the blood-brain and blood-CSF barriers and/or that have low toxicity allowing an increase in the daily dosage should not be used for intrathecal therapy. Intrathecal therapy is accompanied by systemic treatment. Antibacterials indispensable for intrathecal therapy include aminoglycosides, colistin, daptomycin, tigecycline, and vancomycin. Limited experience suggests the utility of the antifungals amphotericin B and caspofungin. Intraventricular administration ensures distribution throughout the CSF compartment, whereas intralumbar dosing often fails to attain adequate antibiotic concentrations in the ventricles. The individual dose is determined by the estimated size of the CSF space and by the estimated clearance from CSF. For moderately lipophilic anti-infectives with a molecular weight above approximately 1,000 g/mol, as well as for hydrophilic drugs with a molecular weight above approximately 400 g/mol, one daily dose is normally adequate. The ventricular drain should be clamped for 15 to 120 min to facilitate the distribution of the anti-infective in the CSF space. Therapeutic drug monitoring of the trough levels is necessary only in cases of therapeutic failure.

show abstract

Section: Introductionmentioning

confidence: 99%

Intrathecal Antibacterial and Antifungal Therapies

2020

View full text Add to dashboard Cite

show abstract

“…Most studies assessing the impact of HAIs have been primarily conducted in ICUs or have focused on a single type of HAI. According this studies HAIs for patients admitted to the neuro-ICU, the rate of HAIs reaches up to 36-40% when admitted for more than 48 h [14,15]. The neuro-ICU patient is particularly vulnerable to pneumonias, due to the high rate of dysphagia and risk of aspiration in patients with neurological diseases [14].…”

Section: Discussionmentioning

confidence: 91%

Healthcare-Associated Infection in Neurosurgical Patients in Ukraine: Results of a Multicenter Study (2017-2019)

Salmanov¹,

Shchehlov²,

Svyrydiuk³

et al. 2021

Wiad Lek

View full text Add to dashboard Cite

The aim: To obtain the estimates of the current prevalence of healthcare-associated infection among neurosurgical patients and determine the antimicrobial resistance of responsible pathogens in Ukraine. Materials and methods: We performed a retrospective multicenter cohort study was based on surveillance data of HAIs among neurosurgical patients from 2017 to 2019 in 7 regional hospitals. Definitions of HAI were used from the CDC/ NHSN. Results: Of 9,711 neurosurgical patients, 1,031 (20.9%) HAIs were observed. The most frequently of HAI types were surgical site infection (53.2%), pneumonia (17.3%), urinary tract infection (15.1%) and bloodstream infection (14.4%). The overall prevalence of HAIs was 20.9% within three months and was 12.8% during one month surveillance period. Death during hospitalization was reported in 11.3% of HAI cases. Escherichia coli were most commonly reported, accounting for 24.3% of all organisms, followed by Staphylococcus aureus (15.9%), Enterococcus spp (14.6%), Pseudomonas aeruginosa (13.4%), and Klebsiella pneumoniae (9.8%). Meticillin resistance was 34.6% of S.aureus isolates. Vancomycin resistance was in 7.1% of isolated enterococci. Among the gram-negative bacteria, third-generation cephalosporins resistance was found in 48.5% of K.pneumoniae and in 34.3% of E. coli isolates. Carbapenem resistance was reported in 11.7% of all included Enterobacteriaceae, also highest in K.pneumoniae, and in 32.4% of P.aeruginosa isolates and in 67.2% of Acinetobacter spp. isolates. Conclusions: Healthcare-associated infections are a cause for mortality and morbidity among hospitalized neurosurgical patients. This is due to increase emergence of antimicrobial-resistant pathogens. Routinely collected surveillance data are of great value as a basis for studying the consequences of HAIs.

show abstract

“…Classical clinical signs and symptoms, such as fever, neck stiffness, and altered mental status, are insensitive and unreliable in HAVM and manifest fully only in a minority of cases [ 1 , 7 ]. Hemorrhage, local inflammatory reactions, and immunosuppression may drastically alter the CSF profile [ 8 ], which may be further compromised by the use of antibiotics and steroids [ 2 , 9 ]. In fact, no single CSF parameter can reliably predict or exclude HAVM [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Hemorrhage, local inflammatory reactions, and immunosuppression may drastically alter the CSF profile [ 8 ], which may be further compromised by the use of antibiotics and steroids [ 2 , 9 ]. In fact, no single CSF parameter can reliably predict or exclude HAVM [ 8 ]. CSF cultures are considered the reference standard and the most important test for diagnosis of HAVM but can be negative in a broad proportion of cases [ 1 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Healthcare-Associated Ventriculitis and Meningitis: A Retrospective Analysis

Coelho

Costa

Martins

et al. 2021

Cureus

View full text Add to dashboard Cite

Background and objectiveHealthcare-associated ventriculitis and meningitis (HAVM) is frequent in neurocritical patients and associated with significant mortality. Surgery and intracranial devices are usually necessary and may lead to infection. Classical clinical signs and cerebral spinal fluid (CSF) analysis may be unreliable. The purpose of this study was to characterize the prevalence of HAVM, risk factors, and interventions in the neurocritical population admitted in the ICU. MethodsThis was a retrospective single-center analysis of all adult neurocritical patients admitted to an ICU during a three-year period. ResultsA total of 218 neurocritical patients were included. The prevalence of HAVM was 13% and it was found to be associated with mortality. When suspected, it was not possible to exclude HAVM in 30% of the patients. HAVM was significantly associated with surgery, surgical reintervention, and brain devices. Sustained fever was the most frequent clinical sign, and it was significantly associated with unexcluded HAVM. CSF cell count was significantly higher in HAVM, though without microbiological isolation in most of the cases. ConclusionBrain damage, interventions, and devices may significantly alter cerebral homeostasis. Sustained fever is very frequent and may be attributed to several conditions. CSF cell count is useful for the diagnosis of HAVM. HAVM is a clinical challenge in the management of neurocritical patients with important therapeutic and prognostic implications.

show abstract

Healthcare-Associated Infections in the Neurocritical Care Unit

Cited by 19 publications

References 114 publications

Intrathecal Antibacterial and Antifungal Therapies

Intrathecal Antibacterial and Antifungal Therapies

Healthcare-Associated Infection in Neurosurgical Patients in Ukraine: Results of a Multicenter Study (2017-2019)

Healthcare-Associated Ventriculitis and Meningitis: A Retrospective Analysis

Contact Info

Product

Resources

About