Post-neurosurgical meningitis
Meningitis remains one of the most dreaded complications of neurosurgical procedures and is common in patients with preexisting infection.
1. usual organisms: Coagulase negative staphylococcus, Staphylococcus aureus, Enterobacteriaceae, Pseudomonas sp., pneumococci usually with basilar skull fractures and otorhinologic surgery
2. empiric antibiotics: vancomycin (to cover MRSA), adult 15 mg/kg q 8-12 hours to achieve trough 15-20mg/dl+cefipime 2 gm IVq 8 hrs
3. if severe PCN allergy, use aztreonam 2gm IV q6-8Hor ciprofloxacin 400mgIV q 8h
4. if severe infection, consider intrathecal therapy delivered daily (use only preservative free drug)
● vancomycin
● tobramycin/gentamicin
● amikacin
● colistin
5. streamline ABXbased on sensitivities,e.g.if organism turns out to be MSSA,change vancomycin oxacillin or nafcillin.
For suspected CSF fistula: usual organisms: streptococci;
Immunocompromised host (e.g. AIDS)
a) usualorganisms:asabovePLUSCryptococcusneoformans,M.tuberculosis,HIVasepticmen- ingitis, L. monocytogenes
b) empiric antifungal agents for cryptococcal meningitis: Induction therapy: Liposomal ampho- tericin B3-4mg/kgIVdaily+flucytosine25mg/kgPOQIDfor at least 2 weeksfollowed by
c) Consolidation therapy: fluconazole 400 mg PO daily for at least 8 weeks followed by
d) Chronic maintenance therapy: fluconazole 200 mg PO daily
Post-neurosurgical meningitis usually occurs in the autumn and winter of the year in Beijing Tian Tan Hospital, Capital Medical University, Beijing, China;. Gram-positive organisms, which are sensitive to compound sulfamethoxazole and vancomycin, are the most common causative pathogens of post-neurosurgical meningitis in the northern mainland of China 1).
Postoperative meningitis is a serious complication occurring after neurosurgical interventions.
Meningitis after surgery is still a serious complication that requires preventative intervention. The clinical outcome of patients with postoperative meningitis after neurovascular surgery is not still satisfactory 2).
Most post-neurosurgical meningitis research has been focused on large cohorts with numerous cases followed over several years. However, the characteristics of post-neurosurgical meningitis in an entire single year are still unclear, and knowledge of these characteristics might influence the selection of appropriate antibiotics and therapeutic strategies for the successful management of this disease.
Epidemiology
Post-neurosurgical meningitis usually occurs in the autumn and winter of the year in the Beijing Tian Tan Hospital, Capital Medical University, Beijing, China hospital 3).
Etiology
Gram positive organisms, which are sensitive to compound sulfamethoxazole and vancomycin, are the most common causative pathogens of post-neurosurgical meningitis in the northern mainland of China 4).