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Content Update

May 23, 2022

Updates in the Recommendations for Pneumococcal Vaccines in Adults: In 2021, two new pneumococcal vaccines, 15- and 20-valent conjugate vaccines (PCV), were approved by the U.S. Food and Drug Administration. With the addition of 2-7 serotypes covered by PCV15 and PCV20, respectively, these new vaccines will cover an estimated 42-65% of causes of invasive pneumococcal disease, which is 15-35% more than PCV13. Accordingly, the Advisory Committee on Immunization Practices (ACIP) adjusted and simplified recommendations for pneumococcal vaccination in adults in late 2021 to reflect these changes in available vaccinations. In the updated Centers for Disease Control and Prevention Immunization Schedule, all eligible patients are now recommended to receive either a single dose of PCV20 or a dose of PCV15 followed by a dose of the 23-valent pneumococcal polysaccharide vaccine (PPSV23).



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

  1. Discuss the pathophysiology of central nervous system (CNS) infections and the impact on antimicrobial treatment regimens (including 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. Outline the initial management strategies for CNS infections.

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

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

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

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

  10. Describe the role of adjunctive agents (eg, dexamethasone) in the management of CNS infections.


The term central nervous system (CNS) infections describes a variety of infections involving the brain and spinal cord and associated tissues, fluids, and membranes, including meningitis, encephalitis, brain abscess, cerebrospinal fluid (CSF) shunt infections, and postoperative infections. image CNS infections, such as meningitis, are considered neurologic emergencies that require prompt recognition, diagnosis, and management to prevent death and residual neurologic deficits. Improperly treated CNS infections are associated with high rates of morbidity and mortality. Despite advances in care, the overall mortality of bacterial meningitis in the United States remains at approximately 15%, and at least 10% to 30% of survivors are afflicted with neurologic impairment, including hearing loss, hemiparesis, and learning disabilities.1,2 Antimicrobial therapy and preventive vaccines have revolutionized management and improved outcomes of bacterial meningitis and other CNS ...

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