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| Approach and implications to rating the quality of evidence and strength of recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology (unrestricted use of the figure granted by the US GRADE Network).Credit: https://academic.oup.com/cid/article/2996079/2017
A team approach is vital to the successful diagnosis
and treatment of complex neurological infections related to placement of
devices in the brain, or as a result of neurosurgery or head trauma. This is
among the recommendations in the first comprehensive guidelines on
healthcare-associated ventriculitis and meningitis, which are being released by
the Infectious Diseases Society of America (IDSA) and published in the
journal Clinical Infectious Diseases.
"These complicated infections affect the central
nervous system and can lead to death and permanent disability if not recognized
and managed appropriately," said Allan R. Tunkel, MD, PhD, lead author of
the guidelines and professor of medicine and associate dean for medical
education at Warren Alpert Medical School of Brown University, Providence, R.I.
"While other guidelines have addressed infections in specific
circumstances, these provide more comprehensive guidance to physicians of
various specialties who care for these complex patients."
The guidelines provide parameters regarding when
clinicians should consider the possibility of ventriculitis (inflammation of
the ventricles in the brain) or meningitis (inflammation of the lining of the
brain or spinal cord) in patients who have cerebrospinal fluid shunts and
drains (devices placed in the brain to relieve pressure due to fluid buildup),
intrathecal drug pumps (for administration of pain medicine or other drugs into
the spinal canal), deep brain
stimulation hardware (medical devices that provide
electrostimulation in the brain to treat Parkinson's disease or other
neurological symptoms) or who have undergone neurosurgery or suffered
from head trauma.
Due to the complexity of these infections, they need to be managed by a
multidisciplinary team most often featuring infectious
diseases (ID) specialists, neurologists, neurosurgeons and
neurocritical care specialists, Dr. Tunkel said.
The guidelines help clinicians determine when to
suspect ventriculitis or meningitis and start patients on appropriate
antimicrobial therapy while awaiting culture results to confirm the infection and
organism causing it. Vancomycin typically is the recommended antimicrobial
agent of choice while clinicians await culture results, due to its success at
combating the staphylococcus bacteria (a common cause of these types of
infections); another antimicrobial agent is also added to treat other potential
organisms. Additionally, the guidelines recommend when a device should be
removed and replaced.
The guidelines also delve into various ways these
infections may be prevented, such asusing prophylactic antibiotics during
placement of the devices, as well as employing "practice bundles,"
specific steps neurosurgeons should take when placing shunts and drains.
"Specialists must work together to ensure proper
management of these patients, which is critically important to improving
outcome," said Dr. Tunkel. "These guidelines offer
currently available evidence for treating these infections, but physicians need
to use individual judgement based on how patients are responding to
therapy."
More information: Allan R. Tunkel et al. 2017 Infectious Diseases Society of
America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis
and Meningitis*, Clinical Infectious Diseases (2017). DOI: 10.1093/cid/ciw861
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Provided by: Infectious Diseases Society of America
https://medicalxpress.com/news/2017-02-complex-neurological-infections-require-team.html
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