Skip to main content
SpringerLink
Log in

Healthcare-Acquired Meningitis and Ventriculitis

  • Chapter
  • First Online:
CNS Infections

  • 1514 Accesses

Abstract

Healthcare-associated meningitis and ventriculitis are infections that complicate craniotomies, CSF shunt, and drain surgeries. They are distinct clinical entities compared to community-acquired meningitis. Gram-positive cocci like Staphylococcus epidermidis and S. aureus are the most common pathogens, followed by Gram-negative rods and anaerobes like P. acnes. The diagnosis can be elusive as other noninfectious neurologic conditions and neurosurgeries can cause similar clinical and CSF findings. The management of these infections often requires surgical interventions and may need intraventricular or intrathecal administration of antimicrobials, as the organisms can be refractory to IV antimicrobials alone. Periprocedural antimicrobials and antimicrobial impregnated catheters have been shown to reduce infection rates.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Tunkel A, Drake J. Cerebrospinal fluid shunt infections. In: Mandell G, Bennett J, Dolin R, editors. Principles and practice of infectious diseases. 7th ed. Philadelphia: Churchill Livingstone; 2009. p. –6.

    Google Scholar 

  2. Arnell K, Cesarini K, Lagerqvist-Widh A, Wester T, Sjolin J. Cerebrospinal fluid shunt infections in children over a 13-year period: anaerobic cultures and comparison of clinical signs of infection with Propionibacterium acnes and with other bacteria. J Neurosurg Pediatr. 2008;1(5):366–72.

    Article  PubMed  Google Scholar 

  3. Lozier AP, Sciacca RR, Romagnoli MF, Connolly Jr ES. Ventriculostomy-related infections: a critical review of the literature. Neurosurgery. 2008;62 Suppl 2:688–700.

    PubMed  Google Scholar 

  4. Coplin WM, Avellino AM, Kim DK, Winn HR, Grady MS. Bacterial meningitis associated with lumbar drains: a retrospective cohort study. J Neurol Neurosurg Psychiatry. 1999;67(4):468–73.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Snowden JN, Beaver M, Smeltzer MS, Kielian T. Biofilm-infected intracerebroventricular shunts elicit inflammation within the central nervous system. Infect Immun. 2012;80(9):3206–14.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Braxton Jr EE, Ehrlich GD, Hall-Stoodley L, et al. Role of biofilms in neurosurgical device-related infections. Neurosurg Rev. 2005;28(4):249–55.

    Article  PubMed  Google Scholar 

  7. Wang KW, Chang WN, Shih TY, et al. Infection of cerebrospinal fluid shunts: causative pathogens, clinical features, and outcomes. Jpn J Infect Dis. 2004;57(2):44–8.

    PubMed  Google Scholar 

  8. Sells CJ, Shurtleff DB, Loeser JD. Gram-negative cerebrospinal fluid shunt-associated infections. Pediatrics. 1977;59(4):614–8.

    CAS  PubMed  Google Scholar 

  9. Brook I. Meningitis and shunt infection caused by anaerobic bacteria in children. Pediatr Neurol. 2002;26(2):99–105.

    Article  PubMed  Google Scholar 

  10. Rekate HL, Ruch T, Nulsen FE. Diphtheroid infections of cerebrospinal fluid shunts. The changing pattern of shunt infection in Cleveland. J Neurosurg. 1980;52(4):553–6.

    Article  CAS  PubMed  Google Scholar 

  11. Nisbet M, Briggs S, Ellis-Pegler R, Thomas M, Holland D. Propionibacterium acnes: an under-appreciated cause of post-neurosurgical infection. J Antimicrob Chemother. 2007;60(5):1097–103.

    Article  CAS  PubMed  Google Scholar 

  12. O’Brien D, Stevens NT, Lim CH, et al. Candida infection of the central nervous system following neurosurgery: a 12-year review. Acta Neurochir (Wien). 2011;153(6):1347–50.

    Article  PubMed  Google Scholar 

  13. Conen A, Walti LN, Merlo A, Fluckiger U, Battegay M, Trampuz A. Characteristics and treatment outcome of cerebrospinal fluid shunt-associated infections in adults: a retrospective analysis over an 11-year period. Clin Infect Dis. 2008;47(1):73–82.

    Article  PubMed  Google Scholar 

  14. Moores LE, Ellenbogen RG. Cerebrospinal fluid shunt infections. In: Hall WA, McCutcheon IE, AANS Publications Committee, editors. Infections in neurosurgery. Park Ridge, IL: American Assowwciation of Neurological Surgeons; 2000. p. –53.

    Google Scholar 

  15. Rabinstein AA, Sandhu K. Non-infectious fever in the neurological intensive care unit: incidence, causes and predictors. J Neurol Neurosurg Psychiatry. 2007;78(11):1278–80.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Berger C, Schwarz S, Schaebitz WR, Aschoff A, Schwab S. Serum procalcitonin in cerebral ventriculitis. Crit Care Med. 2002;30(8):1778–81.

    Article  CAS  PubMed  Google Scholar 

  17. Martinez R, Gaul C, Buchfelder M, Erbguth F, Tschaikowsky K. Serum procalcitonin monitoring for differential diagnosis of ventriculitis in adult intensive care patients. Intensive Care Med. 2002;28(2):208–10.

    Article  CAS  PubMed  Google Scholar 

  18. Schuhmann MU, Ostrowski KR, Draper EJ, et al. The value of C-reactive protein in the management of shunt infections. J Neurosurg. 2005;103(3 Suppl):223–30.

    PubMed  Google Scholar 

  19. Schade RP, Schinkel J, Roelandse FW, et al. Lack of value of routine analysis of cerebrospinal fluid for prediction and diagnosis of external drainage-related bacterial meningitis. J Neurosurg. 2006;104(1):101–8.

    Article  PubMed  Google Scholar 

  20. Pfisterer W, Muhlbauer M, Czech T, Reinprecht A. Early diagnosis of external ventricular drainage infection: results of a prospective study. J Neurol Neurosurg Psychiatry. 2003;74(7):929–32.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Pfausler B, Beer R, Engelhardt K, Kemmler G, Mohsenipour I, Schmutzhard E. Cell index – a new parameter for the early diagnosis of ventriculostomy (external ventricular drainage)-related ventriculitis in patients with intraventricular hemorrhage? Acta Neurochir (Wien). 2004;146(5):477–81.

    Article  CAS  Google Scholar 

  22. Lan CC, Wong TT, Chen SJ, Liang ML, Tang RB. Early diagnosis of ventriculoperitoneal shunt infections and malfunctions in children with hydrocephalus. J Microbiol Immunol Infect. 2003;36(1):47–50.

    PubMed  Google Scholar 

  23. Forgacs P, Geyer CA, Freidberg SR. Characterization of chemical meningitis after neurological surgery. Clin Infect Dis. 2001;32(2):179–85.

    Article  CAS  PubMed  Google Scholar 

  24. Desai A, Lollis SS, Missios S, et al. How long should cerebrospinal fluid cultures be held to detect shunt infections? Clinical article. J Neurosurg Pediatr. 2009;4(2):184–9.

    Article  PubMed  Google Scholar 

  25. Noetzel MJ, Baker RP. Shunt fluid examination: risks and benefits in the evaluation of shunt malfunction and infection. J Neurosurg. 1984;61(2):328–32.

    Article  CAS  PubMed  Google Scholar 

  26. Banks JT, Bharara S, Tubbs RS, et al. Polymerase chain reaction for the rapid detection of cerebrospinal fluid shunt or ventriculostomy infections. Neurosurgery. 2005;57(6):1237–43; discussion 1237–43.

    Article  PubMed  Google Scholar 

  27. Lozier AP, Sciacca RR, Romagnoli MF, Connolly Jr ES. Ventriculostomy-related infections: a critical review of the literature. Neurosurgery. 2002;51(1):170–81; discussion 181–82.

    Article  PubMed  Google Scholar 

  28. Lodise TP, Nau R, Kinzig M, Drusano GL, Jones RN, Sorgel F. Pharmacodynamics of ceftazidime and meropenem in cerebrospinal fluid: results of population pharmacokinetic modelling and Monte Carlo simulation. J Antimicrob Chemother. 2007;60(5):1038–44.

    Article  CAS  PubMed  Google Scholar 

  29. Lodise Jr TP, Rhoney DH, Tam VH, McKinnon PS, Drusano GL. Pharmacodynamic profiling of cefepime in plasma and cerebrospinal fluid of hospitalized patients with external ventriculostomies. Diagn Microbiol Infect Dis. 2006;54(3):223–30.

    Article  CAS  PubMed  Google Scholar 

  30. Nau R, Prange HW, Kinzig M, et al. Cerebrospinal fluid ceftazidime kinetics in patients with external ventriculostomies. Antimicrob Agents Chemother. 1996;40(3):763–6.

    CAS  PubMed Central  PubMed  Google Scholar 

  31. Ricard JD, Wolff M, Lacherade JC, et al. Levels of vancomycin in cerebrospinal fluid of adult patients receiving adjunctive corticosteroids to treat pneumococcal meningitis: a prospective multicenter observational study. Clin Infect Dis. 2007;44(2):250–5.

    Article  CAS  PubMed  Google Scholar 

  32. Wang JH, Lin PC, Chou CH, et al. Intraventricular antimicrobial therapy in postneurosurgical Gram-negative bacillary meningitis or ventriculitis: A hospital-based retrospective study. J Microbiol Immunol Infect. 2012. pii: S1684-1182(12)00204-6. doi: 10.1016/j.jmii.2012.08.028. [Epub ahead of print]

  33. Wilkie MD, Hanson MF, Statham PF, Brennan PM. Infections of cerebrospinal fluid diversion devices in adults: the role of intraventricular antimicrobial therapy. J Infect. 2013;66(3):239–46.

    Article  CAS  PubMed  Google Scholar 

  34. Ng K, Mabasa VH, Chow I, Ensom MH. Systematic review of efficacy, pharmacokinetics, and administration of intraventricular vancomycin in adults. Neurocrit Care. 2014;20(1):158–71. doi: 10.1007/s12028-012-9784-z.

  35. Tangden T, Enblad P, Ullberg M, Sjolin J. Neurosurgical gram-negative bacillary ventriculitis and meningitis: a retrospective study evaluating the efficacy of intraventricular gentamicin therapy in 31 consecutive cases. Clin Infect Dis. 2011;52(11):1310–6.

    Article  PubMed  Google Scholar 

  36. Imberti R, Cusato M, Accetta G, et al. Pharmacokinetics of colistin in cerebrospinal fluid after intraventricular administration of colistin methanesulfonate. Antimicrob Agents Chemother. 2012;56(8):4416–21.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Ziai WC, Lewin 3rd JJ. Improving the role of intraventricular antimicrobial agents in the management of meningitis. Curr Opin Neurol. 2009;22(3):277–82.

    Article  CAS  PubMed  Google Scholar 

  38. Remes F, Tomas R, Jindrak V, Vanis V, Setlik M. Intraventricular and lumbar intrathecal administration of antibiotics in postneurosurgical patients with meningitis and/or ventriculitis in a serious clinical state. J Neurosurg. 2013;119(6):1596–602. doi: 10.3171/2013.6.JNS122126. Epub 2013 Aug 16.

  39. Shah SS, Ohlsson A, Shah VS. Intraventricular antibiotics for bacterial meningitis in neonates. Cochrane Database Syst Rev. 2012;(7):CD004496.

    Google Scholar 

  40. Cook AM, Mieure KD, Owen RD, Pesaturo AB, Hatton J. Intracerebroventricular administration of drugs. Pharmacotherapy. 2009;29(7):832–45.

    Article  CAS  PubMed  Google Scholar 

  41. Brown EM, Edwards RJ, Pople IK. Conservative management of patients with cerebrospinal fluid shunt infections. Neurosurgery. 2006;58(4):657–65; discussion 657–65.

    Article  PubMed  Google Scholar 

  42. The management of neurosurgical patients with postoperative bacterial or aseptic meningitis or external ventricular drain-associated ventriculitis. Infection in Neurosurgery Working Party of the British Society for Antimicrobial Chemotherapy. Br J Neurosurg. 2000;14(1):7–12.

    Google Scholar 

  43. Ellner PD, Neu HC. The inhibitory quotient. A method for interpreting minimum inhibitory concentration data. JAMA. 1981;246(14):1575–8.

    Article  CAS  PubMed  Google Scholar 

  44. Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39(9):1267–84.

    Article  PubMed  Google Scholar 

  45. Schreffler RT, Schreffler AJ, Wittler RR. Treatment of cerebrospinal fluid shunt infections: a decision analysis. Pediatr Infect Dis J. 2002;21(7):632–6.

    Article  PubMed  Google Scholar 

  46. Yogev R. Cerebrospinal fluid shunt infections: a personal view. Pediatr Infect Dis. 1985;4(2):113–8.

    Article  CAS  PubMed  Google Scholar 

  47. James HE, Walsh JW, Wilson HD, Connor JD, Bean JR, Tibbs PA. Prospective randomized study of therapy in cerebrospinal fluid shunt infection. Neurosurgery. 1980;7(5):459–63.

    Article  CAS  PubMed  Google Scholar 

  48. Barker 2nd FG. Efficacy of prophylactic antibiotics against meningitis after craniotomy: a meta-analysis. Neurosurgery. 2007;60(5):887–94; discussion 887–94.

    Article  PubMed  Google Scholar 

  49. Korinek AM, Baugnon T, Golmard JL, van Effenterre R, Coriat P, Puybasset L. Risk factors for adult nosocomial meningitis after craniotomy: role of antibiotic prophylaxis. Neurosurgery. 2006;59(1):126–33; discussion 126–33.

    Article  PubMed  Google Scholar 

  50. Ratilal B, Costa J, Sampaio C. Antibiotic prophylaxis for surgical introduction of intracranial ventricular shunts: a systematic review. J Neurosurg Pediatr. 2008;1(1):48–56.

    Article  PubMed  Google Scholar 

  51. Alleyne Jr CH, Hassan M, Zabramski JM. The efficacy and cost of prophylactic and periprocedural antibiotics in patients with external ventricular drains. Neurosurgery. 2000;47(5):1124–7; discussion 1127–9.

    Article  PubMed  Google Scholar 

  52. Poon WS, Ng S, Wai S. CSF antibiotic prophylaxis for neurosurgical patients with ventriculostomy: a randomised study. Acta Neurochir Suppl. 1998;71:146–8.

    CAS  PubMed  Google Scholar 

  53. Sonabend AM, Korenfeld Y, Crisman C, Badjatia N, Mayer SA, Connolly Jr ES. Prevention of ventriculostomy-related infections with prophylactic antibiotics and antibiotic-coated external ventricular drains: a systematic review. Neurosurgery. 2011;68(4):996–1005.

    PubMed  Google Scholar 

  54. Thomas R, Lee S, Patole S, Rao S. Antibiotic-impregnated catheters for the prevention of CSF shunt infections: a systematic review and meta-analysis. Br J Neurosurg. 2012;26(2):175–84.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Neurologic Infectious Diseases, Department of Infectious Diseases, Cleveland Clinic Foundation, 9500 Euclid Ave, Mail Stop G21, Cleveland, OH, 44195, USA

    Adarsh Bhimraj MD

Authors
  1. Adarsh Bhimraj MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adarsh Bhimraj MD .

Editor information

Editors and Affiliations

  1. Department of Neurology, Hospital de Galdakao-Usansolo, Galdacano, Vizcaya, Spain

    Juan Carlos García-Moncó

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag London

About this chapter

Cite this chapter

Bhimraj, A. (2014). Healthcare-Acquired Meningitis and Ventriculitis. In: García-Moncó, J. (eds) CNS Infections. Springer, London. https://doi.org/10.1007/978-1-4471-6401-2_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-6401-2_3

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-6400-5

  • Online ISBN: 978-1-4471-6401-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation