8
Treatment
Intraventricular Antimicrobial Therapy
➤ Intraventricular antimicrobial therapy should be considered for
patients with healthcare-associated ventriculitis and meningitis in
which the infection responds poorly to systemic antimicrobial therapy
alone (S-L).
➤ When antimicrobial therapy is administered via a ventricular drain,
the drain should be clamped for 15–60 minutes to allow the agent to
equilibrate throughout the CSF (S-L).
➤ Dosages and intervals of intraventricular antimicrobial therapy should
be adjusted based on CSF antimicrobial concentrations to 10–20
times the MIC of the causative microorganism (S-L), ventricular size
(S-L), and daily output from the ventricular drain (S-L).
Optimal Duration of Antimicrobial Therapy
➤ Infections caused by a coagulase-negative Staphylococcus or P. acnes
with no or minimal CSF pleocytosis, normal CSF glucose and few clinical
symptoms or systemic features should be treated for 10 days (S-L).
➤ Infections caused by a coagulase negative Staphylococcus or P. acnes
with significant CSF pleocytosis, CSF hypoglycorrhachia or clinical
symptoms or systemic features should be treated for 10–14 days (S-L).
➤ Infections caused by S. aureus or gram-negative bacilli with or
without significant CSF pleocytosis, CSF hypoglycorrhachia or
clinical symptoms or systemic features should be treated for 10–14
days (S-L). Some experts suggest treatment of infection caused by
gram-negative bacilli for 21 days (W-L).
➤ In patients with repeatedly positive CSF cultures on appropriate
antimicrobial therapy, treatment should be continued for 10–14 after
the last positive culture (S-L).
Catheter Removal
➤ Complete removal of an infected CSF shunt and replacement with an
external ventricular drain, combined with intravenous antimicrobial
therapy, is recommended in patients with infected CSF shunts (S-M).
➤ Removal of an infected CSF drain is recommended (S-M).
➤ Removal of an infected intrathecal infusion pump is recommended
(S-M).
➤ Removal of infected hardware in patients with deep brain stimulation
infections is recommended (S-M).
