9
Patient Monitoring
➤ Patients with healthcare-associated ventriculitis and meningitis
should be monitored for response to treatment based on clinical
parameters (S-L).
➤ In patients with healthcare-associated ventriculitis and meningitis
and an external drainage device, monitoring of CSF cultures is
recommended to ensure that they become negative (S-L).
➤ In patients with no definitive clinical improvement, additional CSF
analysis is recommended to ensure that the CSF parameters have
improved and the cultures become negative (S-L).
➤ For external CSF drains not being used in the treatment of CSF shunt
infection, daily CSF cultures and analysis are NOT recommended
unless clinically indicated (S-L).
Shunt Reimplantion
➤ In patients with infection caused by coagulase-negative staphylococci
or P. acnes, with no associated CSF abnormalities and with negative
CSF cultures for 48 hours after externalization, a new shunt should be
reimplanted as soon as the third day after removal (S-L).
➤ In patients with infection caused by a coagulase-negative
Staphylococcus or P. acnes, and associated CSF abnormalities but
negative repeat CSF cultures, a new shunt should be reimplanted after
7 days of antimicrobial therapy (S-L). If repeat cultures are positive,
antimicrobial treatment is recommended until CSF cultures remain
negative for 7–10 consecutive days before a new shunt is placed (S-L).
➤ In patients with infection caused by S. aureus or gram-negative bacilli,
a new shunt should be reimplanted 10 days after CSF cultures are
negative (S-L).
➤ A period off antimicrobial therapy is NOT recommended to verify
clearing of the infection before shunt reimplantation (S-L).
S, strong ; W, weak — strength of recommendation
H, high; M, moderate; L, low; VL, very low — quality of evidence
