Errolozdalga.com. (2018). [online] Available at: http://errolozdalga.com/medicine/pages/OtherPages/shcAntibiogram2010.pdf [Accessed 6 Nov. 2018].
Base empiric therapy on presumed source of abscess and Gram stain results
Source: mouth, ear, sinus
Source: neurosurgery / post-op
Source: penetrating trauma
Source: hematogenous spread (IE, multiple abscess)
Uptodate: Treatment and prognosis of bacterial brain abscess, accessed 01/10/2017.
What are the clinical, radiologic, and electrophysiologic features of antibiotic-associated encephalopathy (AAE)?
3 types of AAE
*INH does not fit into any of the subtypes.
Bhattacharyya, Shamik et al. “Antibiotic-Associated Encephalopathy”. Neurology 86.10 (2016): 963-971.
The cutoff for significant number of colony forming units to differentiate between colonization and infection depends on the diagnostic test:
Bein, Thomas et al. “The Standard Of Care Of Patients With ARDS: Ventilatory Settings And Rescue Therapies For Refractory Hypoxemia”. Intensive Care Med 42.5 (2016): 699-711. Web. 14 May 2016.
Duration of therapy
Uptodate. Serratia marcescens. Accessed 03/15/2016.
Prepare the following:
1. Three 3-way stopcocks
2. One sterile saline flush (preservative-free)
3. 2-4 10cc syringes
4. sterile gloves, sterile towels
5. gauze with betadine
6. cap, gown, mask
7. antibiotic in 2cc syringe
Put drape underneath shunt access port. Clean shunt access port with betadine thoroughly, paint line and port with betadine. Prepare sterile field (won’t be completely sterile), put on gown, mask and sterile gloves. Prepare stopcock, flush, empty syringe and antibiotic – connect in series as shown in photograph. Maintain one hand as sterile and another hand as “dirty.” Lock CSF drain to patient. Connect free end of stopcock to shunt access port. and open empty syringe (distal port) to patient. Withdraw CSF into empty syringes – draw fluid slowly, to max of 20 cc. (volume equal to or slightly more than amount of antibiotic and sterile flush to be infused). Close empty syringe (now filled with CSF) to patient. Open antibiotic port (proximal port) to patient and push antibiotic slowly. Close antibiotic port and open sterile flush port (middle port) to patient. Flush enough saline to push antibiotic in tubing into patient, and then push an extra 1-2 ml more. Close sterile flush port and disconnect intraventricular infusion set up from shunt access port. Maintain EVD clamped x 1 hour.
TREATMENT OF VENTRICULITIS:
Vancomycin 15mgkg q8-12h (max 2g) plus one of the following
Duration of treatment:
CHOICES: vanc 5-20mg/d; gent 4-8mg/d; ampho 0.1-1mg/d
INTRAVENOUS ABx PROPHYLAXIS PERIOP FOR CNS DEVICE PLACEMENT
Intraventricular application of antibiotics to reach effective concentrations within the CNS
Very comprehensive review of intra-CSF antibiotics was published May, 2018 – author went over 200 articles on this topic – by Mrowczynski, et al published in Clinical Neurology and Neurosurgery. See reference #3 below. A short summary is provided here.
Nau, R., F. Sorgel, and H. Eiffert. “Penetration Of Drugs Through The Blood-Cerebrospinal Fluid/Blood-Brain Barrier For Treatment Of Central Nervous System Infections”. Clinical Microbiology Reviews 23.4 (2010): 858-883.
Mrowczynski, O., Langan, S. and Rizk, E. (2018). Intra-cerebrospinal fluid antibiotics to treat central nervous system infections: A review and update. Clinical Neurology and Neurosurgery, 170, pp.140-158.