Ventriculitis - Revision history

Aidan: /* Management */

2021-05-27T15:14:57Z

Management

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 * Narrow based on culture results
 * Removal of infected shunts, drains, intrathecal pumps, and deep brain stimulators is recommended
 {| class="wikitable sortable"
 ! Organism
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 |}
 {| class="wikitable"
 ! Antimicrobial !! Children !! Adults

Aidan: /* Recommended dosages */

2020-06-30T00:31:32Z

Recommended dosages

← Older revision		Revision as of 00:31, 30 June 2020
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	===Recommended dosages===		===Recommended antimicrobial dosages===
	{\| class="wikitable"		{\| class="wikitable"
	! Antimicrobial !! Children !! Adults		! Antimicrobial !! Children !! Adults

Aidan: /* Management */

2020-06-30T00:14:31Z

Management

← Older revision		Revision as of 00:14, 30 June 2020
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	==Management==		==Management==
	* Empiric antimicrobials are typically indicated, with [[Is treated by::vancomycin]] plus an [[antipseudomonal ~~antibiotic~~]] such as [[Is treated by::ceftazidime]] or [[Is treated by::meropenem]]		* Empiric antimicrobials are typically indicated, with [[Is treated by::vancomycin]] plus an [[antipseudomonal]] such as [[Is treated by::ceftazidime]] or [[Is treated by::meropenem]]
	** If seriously ill, target a vancomycin trough of 15 to 20 μg/mL		** If seriously ill, target a vancomycin trough of 15 to 20 μg/mL
	** [[Ciprofloxacin]] or [[aztreonam]] can be used in cases of β-lactam allergy		** [[Ciprofloxacin]] or [[aztreonam]] can be used in cases of β-lactam allergy
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	*** CSF abnormalities but negative repeat cultures: reimplant after 7 days of antimicrobials		*** CSF abnormalities but negative repeat cultures: reimplant after 7 days of antimicrobials
	*** CSF abnormalities and positive repeat cultures: reimplant after 7 to 10 days of negative cultures		*** CSF abnormalities and positive repeat cultures: reimplant after 7 to 10 days of negative cultures
	** ''[[Staphylococcus aureus]]'' or [[Gram-negative ~~bacillus~~]]: reimplant after 10 days of negative cultures		** ''[[Staphylococcus aureus]]'' or [[Gram-negative bacilli]]: reimplant after 10 days of negative cultures

	===First- and second-line antimicrobials by organism===		===First- and second-line antimicrobials by organism===

Aidan at 00:13, 30 June 2020

2020-06-30T00:13:50Z

← Older revision		Revision as of 00:13, 30 June 2020
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			==Background==
	== Clinical Presentation ==
			===Microbiology===
			* ''[[Staphylococcus epidermidis]]'' and other [[coagulase-negative staphylococci]]
			* ''[[Staphylococcus aureus]]''
			* Gram-negative bacilli, including ''[[Escherichia coli]]'', ''[[Klebsiella]]'', ''[[Proteus]]'', ''[[Pseudomonas]]'', and ''[[Acinetobacter]]''
			* ''[[Cutibacterium acnes]]''

			==Clinical Presentation==
	* Among patients with intraventricular drains, fever (72%) and elevated CSF cell count (93%) were most predictive of ventriculitis [[CiteRef::dorresteijn2019fa]]		* Among patients with intraventricular drains, fever (72%) and elevated CSF cell count (93%) were most predictive of ventriculitis [[CiteRef::dorresteijn2019fa]]

			==Diagnosis==
			* Gram stain and culture of CSF fluid from shunt aspiration, or from external ventricular drain that has a pleiocytosis
			** Prolonged culture of 7-10 days

			==Management==
			* Empiric antimicrobials are typically indicated, with [[Is treated by::vancomycin]] plus an [[antipseudomonal antibiotic]] such as [[Is treated by::ceftazidime]] or [[Is treated by::meropenem]]
			** If seriously ill, target a vancomycin trough of 15 to 20 μg/mL
			** [[Ciprofloxacin]] or [[aztreonam]] can be used in cases of β-lactam allergy
			* Narrow based on culture results
			* Removal of infected shunts, drains, intrathecal pumps, and deep brain stimulators is recommended
			* Infected shunts should be removed and replaced with an EVD
			** ''[[Cutibacterium acnes]]'' or [[coagulase-negative staphylococci]]
			*** No CSF abnormalities and negative cultures within 48 hours of externalization: reimplant as soon as the third day after removal
			*** CSF abnormalities but negative repeat cultures: reimplant after 7 days of antimicrobials
			*** CSF abnormalities and positive repeat cultures: reimplant after 7 to 10 days of negative cultures
			** ''[[Staphylococcus aureus]]'' or [[Gram-negative bacillus]]: reimplant after 10 days of negative cultures

			===First- and second-line antimicrobials by organism===
			{\| class="wikitable sortable"
			! Organism
			! First-line
			! Second-line
			\|-
			\| ''[[Staphylococcus aureus]]'' (methicillin-susceptible) \|\| [[nafcillin]] or [[oxacillin]] \|\| [[vancomycin]]
			\|-
			\| ''[[Staphylococcus aureus]]'' (methicillin-resistant) \|\| [[vancomycin]] \|\| [[daptomycin]], [[TMP-SMX]], or [[linezolid]]
			\|-
			\| ''[[Streptococcus pneumoniae]]'' ([[penicillin]] MIC ≤0.06) \|\| [[penicillin G]] \|\| third-generation cephalosporin
			\|-
			\| ''[[Streptococcus pneumoniae]]'' ([[penicillin]] MIC ≥0.12) \|\| third-generation cephalosporin \|\| [[cefipime]] or [[meropenem]]
			\|-
			\| ''[[Streptococcus pneumoniae]]'' ([[ceftriaxone]] MIC ≥1) \|\| [[vancomycin]] plus a third-generation cephalosporin \|\| [[moxifloxacin]]
			\|-
			\| ''[[Pseudomonas aeruginosa]]'' \|\| [[cefipime]], [[ceftazidime]], or [[meropenem]] \|\| [[aztreonam]] or [[ciprofloxacin]]
			\|-
			\| ''[[Haemophilus influenzae]]'' (β-lactamase negative) \|\| [[ampicillin]] \|\| third-generation cephalosporin, [[cefepime]], or a fluoroquinolone
			\|-
			\| ''[[Haemophilus influenzae]]'' (β-lactamase positive) \|\| third-generation cephalosporin \|\| [[cefepime]], [[aztreonam]], or a fluoroquinolone
			\|-
			\| ESBL Gram-negative bacillus \|\| [[meropenem]] \|\| [[cefepime]] or a fluoroquinolone
			\|-
			\| ''[[Acinetobacter baumannii]]'' \|\| [[meropenem]] \|\| [[colistin]] or [[polymixin B]]
			\|-
			\| Other [[Enterobacteriaceae]] \|\| third-generation cephalosporin \|\| [[meropenem]], [[aztreonam]], [[TMP-SMX]], or [[ciprofloxacin]]
			\|-
			\| ''[[Candida]]'' species \|\| liposomal [[amphotericin B]] ± [[flucytosine]] \|\| [[fluconazole]] or [[voriconazole]]
			\|-
			\| ''[[Aspergillus]]'' species \|\| [[voriconazole]] \|\| liposomal [[amphotericin B]] or [[posaconazole]]
			\|}

			===Recommended dosages===
			{\| class="wikitable"
			! Antimicrobial !! Children !! Adults
			\|-
			\| [[amikacin]] \|\| 22.5 mg/kg divided q8h \|\| 15 mg/kg divided q8h
			\|-
			\| [[amphotericin B]] lipid complex \|\| colspan=2 \| 5 mg/kg q24h
			\|-
			\| [[ampicillin]] \|\| 300-400 mg/kg divided q6h \|\| 12 g divided q4h
			\|-
			\| [[aztreonam]] \|\| 120 mg/kg divided q6-8h \|\| 6-8 g divided q6-8h
			\|-
			\| [[cefepime]] \|\| 150 mg/kg divided q8h \|\| 6 g divided q8h
			\|-
			\| [[cefotaxime]] \|\| 300 mg/kg divided q6-8h \|\| 8-12 g divided q4-6h
			\|-
			\| [[ceftazidime]] \|\| 200 mg/kg divided q8h \|\| 6 g divided q8h
			\|-
			\| [[ceftriaxone]] \|\| 100 mg/kg divided q12-24h \|\| 4 g divided q12h
			\|-
			\| [[ciprofloxacin]] \|\| 30 mg/kg divided q8-12h \|\| 800-1200 mg divided q8-12h
			\|-
			\| [[daptomycin]] \|\| \|\| 6-10 mg/kg divided q24h
			\|-
			\| [[fluconazole]] \|\| 12 mg/kg divided q24h \|\| 400-800 mg divided q24h
			\|-
			\| [[gentamicin]] \|\| 7.5 mg/kg divided q8h \|\| 5 mg/kg divided q8h
			\|-
			\| [[linezolid]] \|\| 30 mg/kg divided q8h (<12 years)<br/>20 mg/kg divided q12h (≥12 years) \|\| 1200 mg divided q12h
			\|-
			\| liposomal [[amphotericin B]] \|\| colspan=2 \| 3-5 mg/kg divided q24h
			\|-
			\| [[meropenem]] \|\| 120 mg/kg divided q8h \|\| 6 g divided q8h
			\|-
			\| [[moxifloxacin]] \|\| \|\| 400 mg divided q24h
			\|-
			\| [[nafcillin]] \|\| 200 mg/kg divided q6h \|\| 12 g divided q4h
			\|-
			\| [[oxacillin]] \|\| 200 mg/kg divided q6h \|\| 12 g divided q4h
			\|-
			\| [[penicillin G]] \|\| 300,000 U/kg divided q4-6h \|\| 24 million U divided q4h
			\|-
			\| [[posaconazole]] \|\| \|\| 800 mg divided q6-12h
			\|-
			\| [[rifampin]] \|\| 20 mg/kg divided q24h \|\| 600 mg divided q24h
			\|-
			\| [[tobramycin]] \|\| 7.5 mg/kg divided q8h \|\| 5 mg/kg divided q8h
			\|-
			\| [[TMP-SMX]] \|\| colspan=2 \| 10-20 mg/kg divided q6-12h
			\|-
			\| [[vancomycin]] \|\| 60 mg/kg divided q6h \|\| 30-60 mg/kg divided q8-12h
			\|-
			\| [[voriconazole]] \|\| 16 mg/kg divided q12h \|\| 8 mg/kg divided q12h
			\|}

	[[Category:CNS infections]]		[[Category:CNS infections]]

Aidan: Created page with "== Clinical Presentation == * Among patients with intraventricular drains, fever (72%) and elevated CSF cell count (93%) were most predictive of ventriculitis CiteRef::dorre..."

2019-11-28T20:37:14Z

Created page with "== Clinical Presentation == * Among patients with intraventricular drains, fever (72%) and elevated CSF cell count (93%) were most predictive of ventriculitis CiteRef::dorre..."

New page

== Clinical Presentation ==
* Among patients with intraventricular drains, fever (72%) and elevated CSF cell count (93%) were most predictive of ventriculitis [[CiteRef::dorresteijn2019fa]]

[[Category:CNS infections]]
[[Category:Trauma and surgical patients]]