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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Discuss the pathophysiology of CNS infections and the impact on antimicrobial treatment regimens (e.g., antimicrobial dosing and CNS penetration).

  2. Describe the signs, symptoms, and clinical presentation of CNS infections.

  3. List the most common pathogens causing CNS infections and identify risk factors for infection with each pathogen.

  4. State the goals of therapy for CNS infections.

  5. Design appropriate empirical antimicrobial regimens for patients suspected of having CNS infections caused by each of the following pathogens (taking age, vaccine history, and other patient-specific information into account), and analyze the impact of antimicrobial resistance on both empirical and definitive therapy: Neisseria meningitidis meningitis, meningitis, Haemophilus influenzae meningitis, Listeria monocytogenes meningitis, group B Streptococcus meningitis, gram-negative bacillary meningitis, postneurosurgical infection, CNS shunt infection, herpes simplex encephalitis.

  6. Modify empirical antimicrobial regimens based on laboratory data and other diagnostic criteria.

  7. Discuss the management of close contacts of patients diagnosed with CNS infections.

  8. Identify candidates for vaccines and other prophylactic therapies to prevent CNS infections.

  9. Describe the role of adjunctive agents (e.g., dexamethasone) in the management of CNS infections.

  10. Formulate a monitoring plan to assess efficacy and adverse effects of therapy for CNS infections.

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KEY CONCEPTS

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  • Image not available. Meningitis is a neurologic emergency that requires prompt recognition, diagnosis, and management to prevent death and residual neurologic defects. Patients with fever, headache, and neck stiffness should be evaluated for meningitis.

  • Image not available. Ideally, lumbar puncture (LP) to obtain cerebrospinal fluid (CSF) for direct examination and laboratory analysis, as well as blood cultures and other relevant cultures, should be obtained before initiation of antimicrobial therapy. However, initiation of antimicrobial therapy should not be delayed if a pretreatment LP cannot be performed.

  • Image not available. The treatment goals for CNS infections are to prevent death and residual neurologic deficits, eradicate or control causative microorganisms, ameliorate clinical signs and symptoms, and identify measures (e.g., vaccination and suppressive therapy) to prevent future infections.

  • Image not available. Prompt initiation of IV high-dose bactericidal antimicrobial therapy directed at the most likely pathogen(s) is essential due to the high morbidity and mortality associated with CNS infections.

  • Image not available. IV antimicrobial therapy is administered for the full course of therapy for CNS infections to ensure adequate CSF penetration throughout the course of treatment.

  • Image not available. Empirical antimicrobial therapy should be directed at the most likely pathogen(s) for a specific patient, taking into account age, risk factors for infection (including underlying disease and immune dysfunction, vaccine history, and recent exposures), CSF Gram stain results, CSF antibiotic penetration, and local antimicrobial resistance patterns.

  • Image not available. Empirical antimicrobial therapy should be modified on the basis of laboratory data and clinical response.

  • Image not available. Close contacts of patients with CNS infections should be evaluated for possible antimicrobial prophylaxis.

  • Image not available. Components of a monitoring plan to assess the efficacy and safety of antimicrobial therapy of CNS infections include clinical signs and symptoms and laboratory data (e.g., CSF findings, culture, and sensitivity data).

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The term CNS infections describes a ...

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