Post-neurosurgical meningitis: Management of cerebrospinal fluid drainage catheters influences the evolution of infection

Clinical infections in neurosurgical oncology: An overview

Central nervous system (CNS) infections are urgent conditions with high morbidity and mortality. Bacteria, viruses, parasites or fungi can cause them. Intracranial infections after craniotomies are an important complication of treatment, especially in oncological patients that are already immunologically compromised due to the disease and treatment. The consequence of CNS infections in oncological patients includes longer treatment with antibiotics, additional surgical procedures, higher treatment costs and poorer treatment outcomes. Additionally, the management of primary pathology may be prolonged or postponed as a result of the active infection. By introducing new and improved protocols, tightening controls on their implementation, constantly educating the entire team involved in patient treatment and educating both patients and relatives, the incidence of infections can be reduced effectively.

Postoperative cerebrospinal fluid infection by Ralstonia mannitolilytica: Two case reports and a literature review

Background

Ralstonia species are Gram-negative bacilli that are commonly found in moist environments, such as water and soil. They are opportunistic human pathogens, particularly found among immunocompromised patients, and are an infrequent cause of infection. The difficulty in correctly identifying and differentiating between Ralstonia species members using routine biochemical methods as well as their resistance to many classes of antibiotics poses a specific diagnostic and therapeutic challenge.

Case Description

We report two cases from our neurosurgical unit complicated by postoperative cerebrospinal fluid infection caused by Ralstonia Mannitolilytica that posed a therapeutic challenge.

Conclusion

Our hypothesis is contaminated irrigation fluids might be a significant cause of post-operative meningitis and prolonged hospital stay.

Prevalence of Ventriculostomy Related Infections and Associated Factors in Low Income Setup

Background

Ventriculostomy, a lifesaving and emergency procedure, is used to address raised intracranial pressure. In resource limited set-up like Tikur Annbessa Specialized Referral Hospital, properly designed closed system for ventriculostomy is not available; a device made with sterile pediatric nasogastric tube connected to urine bag is used.

Methods

Institutional based retrospective cross-sectional study conducted on 93 patients with ventriculostomy from January 1, 2009 to June 30, 2018. Ventriculostomy related infection risk described in descriptive statistics and Binary Logistic Regression analysis.

Results

The prevalence rate of Ventriculostomy related infection is 25.8% at Tikur Annbessa Specialized Referral Hospital. Identified risk factors: Ventriculostomy stay for five or more days (AOR=7.676, 95% CI: 1.424, 41.367) and cerbro-spinal fluid leak (AOR=4.592, 95% CI: 1.279, 16.488). Ventriculostomy manipulation showed association on bivariate analysis. K.Pneumoniae (34.6%) and Acinetobacter spp. (30.8%) identified as the main organisms. They were sensitive to combined ceftazidime and vancomycin in 19.2% and meropenem in 42.3%. Based on Tängdén's criteria, 11.8% of patients died of Ventriculostomy related infection while 43% of the patients died in total. Mortality from Ventriculostomy related infection is 45.8% once diagnosed.

Conclusion

The prevalence rate of Ventriculostomy related infection is 25.8% at Tikur Annbessa Specialized Referral Hospital. The duration of external ventricular drain and Cerebrospinal fluid leak are identified risk factors. Ventriculostomy related infection is responsible for one third of mortality related with external ventricular drain. The remaining two third exact causes are not known.

Meningitis and encephalitis management in the ICU

PURPOSE OF REVIEW

Management of patients with meningitis and encephalitis oftentimes requires ICU level of care. This article is an update on management for meningitis and encephalitis with focus on clinical care in the ICU. Information provided is based on a review of recent studies with focus on studies since 2017.

RECENT FINDINGS

Advances in diagnostic and treatment approach for different pathogens are presented. Nosocomial meningitis now constitutes a major part of brain infections seen in ICUs in the developed world. Advances in ICU care of central nervous system (CNS) infections include application of newer diagnostic methods, improved understanding and delivery of antibiotics to the CNS, infection prevention for nosocomial infections, and application of neuromonitoring where indicated.

SUMMARY

Advances in diagnostics and therapeutic approach to CNS infections are continually made. For intensivists, focus on neuromonitoring and brain resuscitation in critically ill patients with CNS infections may present a path to enhance preservation of brain function and improve outcomes. VIDEO ABSTRACT: http://links.lww.com/COCC/A22.

Device-Associated Meningitis by Linezolid-Resistant Staphylococcus haemolyticus in a Vancomycin- Hypersensitive Patient

Postsurgical device-related meningitis caused by multidrug-resistant coagulase-negative staphylococci often complicates the treatment options. We report a rare and, to our knowledge, the first clinical case report of drain-associated meningitis caused by methicillin- and linezolid-resistant Staphylococcus haemolyticus following linezolid therapy in a vancomycin-hypersensitive patient subsequently treated with cotrimoxazole, resulting in clinical improvement. The molecular mechanisms responsible for linezolid resistance were found to be the presence of G2576T mutation in domain V of 23srRNA region, which often arises during linezolid usage and also carriage of cfr gene, which promotes resistance independent of antibiotic pressure. We emphasize on monitoring the rational use of linezolid to avoid the spread of resistance and also comprehensive perioperative care to prevent health care-associated infection.

Healthcare-Associated Infections in the Neurocritical Care Unit

PURPOSE OF REVIEW

This article summarizes updated data and knowledge on healthcare-associated infections in the neurocritical care unit, with a focus on central nervous system infections and systemic infectious complications in patients with acute brain disease. It also reviews the concept of brain injury-induced immune modulation, an underlying mechanism to explain why the neuro-ICU population is particularly susceptible to infections.

RECENT FINDINGS

Healthcare-associated infections in the neuro-ICU are common: up to 40 % of meningitides in the developed world are now healthcare-associated. The number of gram-negative infections is rising. New diagnostic approaches attempt to aid in the diagnosis of healthcare-associated meningitis and ventriculitis. Healthcare-associated infections in the neurocritical care unit remain a challenge for diagnosis, treatment, and prevention. Gaining a better understanding of at-risk patients and development of preventative strategies will be the goal for future investigation.

Myroides odoratus Central Nervous Infection in a Postneurosurgery Patient

The organisms belonging to the genus Myroides are ubiquitously present in the environment and have been implicated in infections in immunocompromised patients. We report the recent isolation of Myroides odoratus from the cerebrospinal fluid (CSF) of a patient with anaplastic astrocytoma in the right frontal lobe who had undergone a supratentorial craniectomy for a recurrent right frontal tumor. The organism was identified by the VITEK-2 automated identification system (BioMérieux, Marcy-l'Étoile, France) in addition to microscopic morphology, cultural characteristics, and biochemical tests. The recovery of pure culture of M. odoratus from CSF culture and the patient's clinical response to treatment with cefoperazone–sulbactam support its potential etiological role. M. odoratus can be a causative agent of postneurosurgery central nervous system infection and is amenable to treatment with appropriate antibiotics.