Medical device-associated meningitis/ventriculitis – shunt, external ventricular drain (EVD), intrathecal infusion pump, deep brain stimulation hardware
[Clin Infect Dis 2017;64:e34-65.]
- Send blood and CSF for aerobic and anaerobic culture. If EVD, collect CSF from tubing, not collection bag. Tailor antibiotics to C&S results.
- Shunt removal should be done ASAP.
- A new shunt can be reimplanted:
- infection caused by S. epidermidis or C. acnes, with no associated CSF abnormalities and with negative CSF cultures for 48 hours after externalization - a new shunt can be reimplanted as soon as the third day after removal
- infection caused by S. epidermidis or C. acnes, with associated CSF abnormalities and:
- negative repeat CSF cultures - a new shunt can be reimplanted after 7 days of antimicrobial therapy
- positive repeat CSF cultures - continue antimicrobial therapy for 7-10 days after CSF cultures negative, after which a new shunt can be reimplanted
- infection caused by S. aureus or Gram negative bacilli - a new shunt can be reimplanted 10 days after CSF cultures are negative.
Usual Pathogens
S. epidermidis
S. aureus/MRSA
Cutibacterium acnes
Corynebacterium spp
Enterobacterales
P. aeruginosa
Acinetobacter baumannii
Rare: Candida spp
| Empiric Therapy | Dose | Duration |
|---|---|---|
|
If Gram positive in blood or CSF Gram stain/cultures: | ||
| Ceftriaxone | 2g IV q12h | See Duration in Culture-directed Medical device-associated meningitis/ventriculitis. |
| + | ||
| Vancomycin | 15mg/kg IV q8-12h | |
| If Gram negative, or no organism identified, in blood or CSF Gram stain/cultures: | ||
| [Ceftazidime | 2g IV q8h | See Duration in Culture-directed Medical device-associated meningitis/ventriculitis. |
| or | ||
| Meropenem] | 2g IV q8h | |
| + | ||
| Vancomycin | 15mg/kg IV q8-12h | |