Bacteriële CZS infecties

Initiatief: SWAB Aantal modules: 9

Antimicrobiële behandeling meningitis

Uitgangsvraag

Specific antimicrobial treatment.

Aanbeveling

Bacterial meningitis caused by penicillin susceptible (MIC≤0.06) S. pneumoniae should be treated with penicillin 200.000 IU/kg/day (4h – maximum 12 million units) in children and penicillin 12 million IU /day (4h or continuously) in adults, for a minimum of 10 days. Meningitis due to S. pneumoniae with intermediate resistance (0.06<MIC≤2.0) should be treated with ceftriaxone 100 mg/kg/day (24h – max 4g) in children and ceftriaxone 4 g/day (12h) or cefotaxime 8-12 g/day (4-6h) in adults, for a minimum of 10 days. Meningitis due to penicillin-resistant S. pneumoniae (MIC >2.0) should be treated with vancomycin 60 mg/kg/day (12h – max 2g)  plus ceftriaxone 100 mg/kg/day (24h – max 4g) in children and vancomycin 2 g/day (12h)  plus ceftriaxone 4 g/day (12h) or cefotaxime 8-12 g/day (4-6h) in adults.

 

Bacterial meningitis caused by penicillin susceptible N. meningitidis should be treated with penicillin 200.000 IU/kg/day (4h – maximum 12 million units) in children and penicillin 12 million IU /day (4h or continuously) in adults, for 7 days. Penicillin resistant strains (MIC >0.25) should be treated with ceftriaxone 100 mg/kg/day (24h – max 4g) in children and ceftriaxone 4 g/day (12h) or cefotaxime 8-12 g/day (4-6h) in adults, for 7 days.

 

Bacterial meningitis caused by L. monocytogenes should be treated with amoxicillin 200 mg/kg/day (6h – max 12g ) in children and amoxicillin 12 g/day (4h) in adults, for at least 21 days. 

 

Bacterial meningitis caused by H. influenzae, ß-lactamase positive or ß-lactamase unknown, should be treated with ceftriaxone 100 mg/kg/day (24h – max 4 g) in children and ceftriaxone 4 gr/day (12h) or cefotaxime 8-12 gr/day (4-6h) in adults, for 7 days. If the strain is susceptible to amoxicillin, it should be treated with amoxicillin 200 mg/kg/day (6h – max 12g) in children and amoxicillin 12g/day (4h) in adults, for 7 days.

 

Bacterial meningitis caused by Streptococcus agalactiae should be treated with penicillin 200.00 IU/kg/day (4h – maximum 12 million units) and penicillin 12 million units/day (4h or continuously) in adults, for at least 14 days. 

 

Bacterial meningitis caused by Escherichia coli should be treated with cefotaxime  plus gentamicin for 3 days in neonates (dose depends on gestational age and birth weight – SWAB website), ceftriaxone 100 mg/kg/day (24h – max 4g) for children and ceftriaxone 4g (12h) or cefotaxime 8-12g/day (4-6h) in adults, for 21 days. ESBL positive strains should be treated with meropenem 120mg/kg/day (8h - maximum 6 g) in children and 6g (8h) for adults.

 

Bacterial meningitis with negative CSF and blood cultures after 48 hours should be treated with ceftriaxone 100 mg/kg/day (24h – max 4g) in children and amoxicillin 12g/day (4h) in adults, for 14 days.

Overwegingen

For this module no considerations have been formulated. 

Onderbouwing

Level 1

No randomized controlled trials or adequate comparative studies have been performed to determine the optimal antibiotic treatment duration of bacterial meningitis caused by specific pathogens or in culture negative cases.

 

A1 Karageorgeopoulous (2007)25, vd Beek (2010)26

A summary of specific antimicrobial treatment for bacterial meningitis when a causative organism is identified is presented in Table 3. No randomized controlled trials or comparative studies have been performed to compare the efficacy of different antibiotics in bacterial meningitis due to specific bacteria. Therefore, the choice of specific antimicrobial therapy is based on bacterial susceptibility testing.

 

Studies on optimal treatment duration are scarce. A 2010 meta-analysis on randomized trials comparing short (4-7 days) versus long duration (7-14 days) of antibiotic therapy for bacterial meningitis concluded that there was no difference in outcome between treatment durations.25 However, there were several biases in the included studies and the results can not be extrapolated to the unselected population of community-acquired bacterial meningitis.26 A recent study performed in Malawi compared the use of a 5 day regimen with a the standard 10 day regimen in children with uncomplicated bacterial meningitis due to H. influenzae, N. meningitidis or S. pneumoniae. The study showed equality of both regimens.27 However, the subgroup of children with pneumococcal meningitis was too small to conclude that there was no harm of early discontinuation, especially since the mortality was 8% in the 5 day regimen group vs. 5% in the 10 day group.27 Therefore, the results of this trial can not be extrapolated to the Netherlands.

 

Currently, the duration of antibiotic treatment is based on expert opinion. New studies on optimal treatment duration are needed. The level of evidence for treatment duration is therefore categorized as level 4.28

 

Table 3. Specific antimicrobial therapy for community-acquired bacterial meningitis based on causative microorganism

Micro-organism

Standard treatment

Alternative therapy

Duration

S. pneumoniae

        MIC ≤0.06 g/ml

 

penicillin G 

 

ceftriaxone or cefotaxime

 

10-14 days

0.06<MIC≤2.0μg/ml

ceftriaxone or cefotaxime

meropenem

10-14 days

MIC >2.0μg/ml

vancomycin plus either ceftriaxone or cefotaxime

vancomycin plus meropenem

 

N. meningitidis

        MIC ≤0.25μg/ml

 

penicillin G 

 

ceftriaxone or cefotaxime

 

7 days

        MIC >0.25μg/ml

ceftriaxone or cefotaxime

meropenem or chloramphenicol

7 days

H. influenzae

ceftriaxone or cefotaxime

meropenem or chloramphenicol

7/10 daysa

L. monocytogenes

amoxicillin or penicillin G

trimethoprim-sulfamethoxazole

≥21 days

S. agalactiae

 

penicillin G or amoxicillin 

 

ceftriaxone or cefotaxime

 

≥14 days

 

aDuration of treatment in children 10 days, adults 7 days.

 

What is the optimal antibiotic therapy and duration for community-acquired bacterial meningitis caused by Streptococcus pneumoniae?

Resistance of S. pneumoniae to penicillin and third generation cephalosporins (cefotaxime or ceftriaxone) has been reported to cause treatment failure.6 The rate of pneumococcal resistance rates in the Netherlands is still very low, with only 0.5-1% strains showing intermediate resistance to penicillin (0.06<MIC≤2.0).10,11 So far, one strain resistant to third generation cephalosporins has been described (MIC>2.0).29 Therefore, in the overwhelming majority of patients with pneumococcal meningitis monotherapy with amoxicillin or penicillin suffices. When susceptibility testing shows intermediate resistance to penicillin, a third generation cephalosporin should be used. Patients at risk for infection with a resistant strain, such as inhabitants of countries with high pneumococcal resistance rates (e.g. South-European countries, or the US) or recent travelers from these countries should be treated with combination therapy consisting of vancomycin and a third generation cephalosporin until susceptibility testing is performed.6 When the isolate shows resistance to penicillin (MIC>2.0), combination therapy of vancomycin and a third generation cephalosporin should be used. The duration of therapy for S. pneumoniae meningitis is 10 days, unless persistent or recurrent fever or other complications occur that warrant prolonged treatment.28 

 

What is the optimal antibiotic therapy and duration for community-acquired bacterial meningitis caused by Neisseria meningitidis?

Currently (2012), there is no consensus in Europe about the penicillin breakpoints of N.meningitidis. According to EUCAST the meningococcus has intermediate resistance (reduced susceptibility) when the penicillin MIC is >0.06 en ≤0.25 mg/l. Meningococcal strains with reduced susceptibility to penicillin have been described, but the clinical significance remains unclear. In the Netherlands, 17 of 392 (4%) meningococcal strains isolated from CSF between 2005-2009 showed intermediate resistance to penicillin. In 2010 the number increased to 10 out of 54 (19%). Penicillin-resistant strains are very rare. The majority of patients with N. meningitidis strains with intermediate resistance to penicillin reported in the literature have responded well to penicillin treatment.6 Treatment failures have been described in a few case reports, and none of these occurred in the Netherlands. Therefore, treatment with amoxicillin or penicillin for 7 days remains first choice.28 Infection with a penicillinresistant strain (MIC >0.25) should be treated with a third generation cephalosporin.6

 

All meningococcal meningitis cases have to be reported to the Public Health Service (GGD/GG&GD). Household contacts and others who have been in close contact with meningococcal meningitis patients in the week prior to disease onset should receive prophylaxis to minimize the risk of secondary cases. Health care workers are only at risk after intimate contact such as mouth-to mouth resuscitation or endotracheal intubation. Rifampicin and ciprofloxacin are both effective as prophylaxis for treating patient contacts.3 More information on this subject can be found in the bacterial meningitis guidelines of the Dutch Neurological Society.3 

 

 

What is the optimal antibiotic therapy and duration for community-acquired bacterial meningitis caused by Listeria monocytogenes?

Amoxicillin and penicillin are highly effective against L. monocytogenes, and one of these should be used in patients with proven or suspected L. monocytogenes meningitis. Third generation cephalosporins are ineffective against this pathogen and therefore empirical monotherapy with these agents in patients at higher risk for L. monocytogenes meningitis, e.g. elderly (>50 years) and immunocompromised patients, should be avoided.24 As it is difficult to define patients that have an increased risk of L. monocytogenes, the empirical treatment for all adults includes amoxicillin to cover L. monocytogenes. Patients allergic to penicillin can be treated with trimethoprimsulfamethoxazole.6 

The addition of aminoglycosides is debated. Synergistic activity of gentamicin with other antibiotics has been shown in in vitro experiments. However, a cohort of 118 Spanish adults with L. monocytogenes disease showed increased mortality and renal failure in the aminoglycoside-treated patients.30 Therefore, aminoglycosides are not advised in adults with L. monocytogenes meningitis. Minimal duration of treatment of L. monocytogenes meningitis is 21 days for children and adults.28,31,32 

 

What is the optimal antibiotic therapy and duration for community-acquired bacterial meningitis caused by Haemophilus influenzae?

The rate of beta-lactamase producing H. influenzae strains in the Netherlands has fluctuated in the last 25 years from 0.9% to 12.5%, with an average around 5% (data NRLBM). Therefore, third generation cephalosporins have become standard for H. influenzae meningitis, until susceptibility testing is performed. If the strain is susceptible to amoxicillin, amoxicillin should be used. The standard duration of therapy for adults is 7 days and for children 10 days.28,32

 

What is the optimal antibiotic therapy and duration for community-acquired bacterial meningitis caused by Streptococcus agalactiae?

S. agalactiae is invariably susceptible to penicillin, amoxicillin, and cephalosporins. Treatment of S. agalactiae meningitis consists of penicillin or amoxicillin, and alternatively third generation cephalosporins can be used. The minimal advised treatment duration is 14 days, but courses up to 21 days should be considered in patients with a complicated disease course. In neonates with S. agalactiae meningitis gentamicin is added for 3 days.

 

What is the optimal antibiotic therapy and duration for community-acquired bacterial meningitis caused by Escherichia coli?

E. coli strains are mostly susceptible to third generation cephalosporins and 30-40% is susceptible to amoxicillin. Strains producing extended spectrum beta-lactamases (ESBL) are increasing in frequency but have not been described in meningitis patients in the Netherlands so far. Treatment of E. coli meningitis consists of third generation cephalosporins combined with gentamicin during the first three days of treatment in neonates. In children beyond the neonatal age and adults third generation cephalosporins are advised, or amoxicillin if the strain is sensitive to amoxicillin. When ESBL producing E. coli are suspected or proven, meropenem is the treatment of choice. The minimal advised treatment duration is 21 days.

 

What is the optimal antibiotic therapy and duration for community-acquired bacterial meningitis caused by unidentified pathogens (culture-negative cases)?

In 10 to 20% of bacterial meningitis cases, defined by elevated CSF markers of inflammation, CSF and blood cultures remain negative.6 No studies have been performed to determine the treatment regimen for these patients and the optimal duration of therapy is therefore also unclear. The given recommendations are based on the duration of therapy advised for the most common causative microorganisms. For children empirical therapy with a third generation cephalosporin should be continued for 14 days in culture-negative cases. In adults the empirical therapy can be changed, from amoxicillin combined with a third generation cephalosporin to monotherapy with amoxicillin for 14 days if after 48 hours cultures remain negative. Monotherapy amoxicillin is the antimicrobial therapy of choice in adults because infection with β-lactamase producing H. influenzae is virtually excluded if cultures remain negative after 48 hours. L. monocytogenes should still be covered after 48 hours as it is a slow growing microorganism. As L. monocytogenes is extremely rare in children beyond the neonatal age, monotherapy with a third generation cephalosporin suffices for children.

  1. CBO. Kwaliteitsinstituut voor de Gezondheidszorg CBO, Handleiding voor werkgroepleden. http://www.cbo.nl/Downloads/222/EBRO_handl_totaal.pdf
  2. van de Beek D, Weisfelt M, de Gans J, Tunkel AR, Wijdicks EF. Drug Insight: adjunctive therapies in adults with bacterial meningitis. Nat Clin Pract Neurol 2006; 2: 504-16.
  3. van de Beek D, Brouwer MC, de Gans J et al. Richtlijn bacteriele meningitis. Utrecht: Nederlandse Vereniging voor Neurologie; 2011.
  4. van de Beek D, Drake JM, Tunkel AR. Nosocomial bacterial meningitis. N Engl J Med 2010; 362: 146-54.
  5. Bohr V, Rasmussen N, Hansen B et al. 875 cases of bacterial meningitis: diagnostic procedures and the impact of preadmission antibiotic therapy. Part III of a three-part series. J Infect 1983; 7: 193-202.
  6. Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol Rev 2010; 23: 467-92.
  7. Spanos A, Harrell FE, Jr., Durack DT. Differential diagnosis of acute meningitis. An analysis of the predictive value of initial observations. JAMA 1989; 262: 2700-7.
  8. Tunkel AR. Brain abscess. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practive of infectious diseases. 7 ed. Philadelphia: Churchill livingstone; 2010. p. 1265-78.
  9. Kastenbauer S, Pfister HW, Wispelwey B, Scheld WM. Brain abscess. In: Scheld WM, Whitley RJ, Marra CM, editors. Infections of the central nervous system. 3 ed. Philadelphia: Lippincott Williams & Wilkins; 2004. p. 479-507.
  10. van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004; 351: 1849-59.
  11. Brouwer MC, Heckenberg SG, de GJ, Spanjaard L, Reitsma JB, van de Beek D. Nationwide implementation of adjunctive dexamethasone therapy for pneumococcal meningitis. Neurology 2010.
  12. van de Beek D, de Gans J, Tunkel AR, Wijdicks EF. Community-acquired bacterial meningitis in adults. N Engl J Med 2006; 354: 44-53.
  13. Garges HP, Moody MA, Cotten CM et al. Neonatal meningitis: what is the correlation among cerebrospinal fluid cultures, blood cultures, and cerebrospinal fluid parameters? Pediatrics 2006; 117: 1094-100.
  14. Hristeva L, Booy R, Bowler I, Wilkinson AR. Prospective surveillance of neonatal meningitis. Arch Dis Child 1993; 69: 14-8.
  15. Holt DE, Halket S, de LJ, Harvey D. Neonatal meningitis in England and Wales: 10 years on. Arch Dis Child Fetal Neonatal Ed 2001; 84: F85-F89.
  16. Galiza EP, Heath PT. Improving the outcome of neonatal meningitis. Curr Opin Infect Dis 2009; 22: 229-34.
  17. Heath PT, Nik Yusoff NK, Baker CJ. Neonatal meningitis. Arch Dis Child Fetal Neonatal Ed 2003; 88: F173-F178.
  18. Siegal T, Pfeffer MR, Steiner I. Antibiotic therapy for infected Ommaya reservoir systems. Neurosurgery 1988; 22: 97-100.
  19. Cooper MD, Keeney RE, Lyons SF, Cheatle EL. Synergistic effects of ampicillin-aminoglycoside combinations on group B streptococci. Antimicrob Agents Chemother 1979; 15: 484-6.
  20. Netherlands Reference Laboratory for Bacterial Meningitis (AMC/RIVM). Bacterial meningitis in the Netherlands Annual report 2010. Amsterdam: University of Amsterdam; 2011.
  21. Odio CM, Puig JR, Feris JM et al. Prospective, randomized, investigator-blinded study of the efficacy and safety of meropenem vs. cefotaxime therapy in bacterial meningitis in children. Meropenem Meningitis Study Group. Pediatr Infect Dis J 1999; 18: 581-90.
  22. Brouwer MC, Heckenberg SG, de Gans J, Spanjaard L, Reitsma JB, van de Beek D. Nationwide implementation of adjunctive dexamethasone therapy for pneumococcal meningitis. Neurology 2010; 75: 1533-9.
  23. Heckenberg SG, de Gans J, Brouwer MC et al. Clinical features, outcome, and meningococcal genotype in 258 adults with meningococcal meningitis: a prospective cohort study. Medicine (Baltimore) 2008; 87: 185-92.
  24. Brouwer MC, van de Beek D, Heckenberg SG, Spanjaard L, de Gans J. Community-acquired Listeria monocytogenes meningitis in adults. Clin Infect Dis 2006; 43: 1233-8.
  25. Karageorgopoulos DE, Valkimadi PE, Kapaskelis A, Rafailidis PI, Falagas ME. Short versus long duration of antibiotic therapy for bacterial meningitis: a meta-analysis of randomised controlled trials in children. Arch Dis Child 2009; 94: 607-14.
  26. van de Beek D, Brouwer MC. No difference between short-course and long-course antibiotics for bacterial meningitis in children, but available evidence limited. Evid Based Med 2010; 15: 6-7.
  27. Molyneux E, Nizami SQ, Saha S et al. 5 versus 10 days of treatment with ceftriaxone for bacterial meningitis in children: a double-blind randomised equivalence study. Lancet 2011; 377: 1837-45.
  28. Tunkel AR, Hartman BJ, Kaplan SL et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004; 39: 1267-84.
  29. van der Meer H, van ZA, Spanjaard L, Van FM. [An infant with meningitis caused by resistant pneumococcus: infection despite vaccination]. Ned Tijdschr Geneeskd 2012; 156: A3806.
  30. Mitja O, Pigrau C, Ruiz I et al. Predictors of mortality and impact of aminoglycosides on outcome in listeriosis in a retrospective cohort study. J Antimicrob Chemother 2009; 64: 416-23.
  31. Lorber B. Listeriosis. Clin Infect Dis 1997; 24: 1-9.
  32. Red Book: 2009 report of the committee on infectious diseases. 28 ed. Elk Grove Village, IL, USA: American Academy of Pediatrics; 2009.
  33. Falagas ME, Bliziotis IA, Tam VH. Intraventricular or intrathecal use of polymyxins in patients with Gram-negative meningitis: a systematic review of the available evidence. Int J Antimicrob Agents 2007; 29: 9-25.
  34. Lozier AP, Sciacca RR, Romagnoli MF, Connolly ES, Jr. Ventriculostomy-related infections: a critical review of the literature. Neurosurgery 2008; 62 Suppl 2: 688-700.
  35. Mayhall CG, Archer NH, Lamb VA et al. Ventriculostomy-related infections. A prospective epidemiologic study. N Engl J Med 1984; 310: 553-9.
  36. Stenager E, Gerner-Smidt P, Kock-Jensen C. Ventriculostomy-related infections--an epidemiological study. Acta Neurochir (Wien ) 1986; 83: 20-3.
  37. Coplin WM, Avellino AM, Kim DK, Winn HR, Grady MS. Bacterial meningitis associated with lumbar drains: a retrospective cohort study. J Neurol Neurosurg Psychiatry 1999; 67: 468-73.
  38. Lyke KE, Obasanjo OO, Williams MA, O'Brien M, Chotani R, Perl TM. Ventriculitis complicating use of intraventricular catheters in adult neurosurgical patients. Clin Infect Dis 2001; 33: 2028-33.
  39. Wong GK, Poon WS, Wai S, Yu LM, Lyon D, Lam JM. Failure of regular external ventricular drain exchange to reduce cerebrospinal fluid infection: result of a randomised controlled trial. J Neurol Neurosurg Psychiatry 2002; 73: 759-61.
  40. Pfisterer W, Muhlbauer M, Czech T, Reinprecht A. Early diagnosis of external ventricular drainage infection: results of a prospective study. J Neurol Neurosurg Psychiatry 2003; 74: 929-32.
  41. Park P, Garton HJ, Kocan MJ, Thompson BG. Risk of infection with prolonged ventricular catheterization. Neurosurgery 2004; 55: 594-9.
  42. Arabi Y, Memish ZA, Balkhy HH et al. Ventriculostomy-associated infections: incidence and risk factors. Am J Infect Control 2005; 33: 137-43.
  43. Schade RP, Schinkel J, Visser LG, Van Dijk JM, Voormolen JH, Kuijper EJ. Bacterial meningitis caused by the use of ventricular or lumbar cerebrospinal fluid catheters. J Neurosurg 2005; 102: 229-34.
  44. Ohrstrom JK, Skou JK, Ejlertsen T, Kosteljanetz M. Infected ventriculostomy: bacteriology and treatment. Acta Neurochir (Wien ) 1989; 100: 67-9.
  45. Vinchon M, Dhellemmes P. Cerebrospinal fluid shunt infection: risk factors and long-term follow-up. Childs Nerv Syst 2006; 22: 692-7.
  46. Conen A, Walti LN, Merlo A, Fluckiger U, Battegay M, Trampuz A. Characteristics and treatment outcome of cerebrospinal fluid shunt-associated infections in adults: a retrospective analysis over an 11year period. Clin Infect Dis 2008; 47: 73-82.
  47. Walters BC, Hoffman HJ, Hendrick EB, Humphreys RP. Cerebrospinal fluid shunt infection. Influences on initial management and subsequent outcome. J Neurosurg 1984; 60: 1014-21.
  48. Filka J, Huttova M, Tuharsky J, Sagat T, Kralinsky K, Krcmery V, Jr. Nosocomial meningitis in children after ventriculoperitoneal shunt insertion. Acta Paediatr 1999; 88: 576-8.
  49. Kestle JR, Garton HJ, Whitehead WE et al. Management of shunt infections: a multicenter pilot study. J Neurosurg 2006; 105: 177-81.
  50. Sacar S, Turgut H, Toprak S et al. A retrospective study of central nervous system shunt infections diagnosed in a university hospital during a 4-year period. BMC Infect Dis 2006; 6:43.: 43.
  51. Korinek AM, Baugnon T, Golmard JL, van Effenterre R, Coriat P, Puybasset L. Risk factors for adult nosocomial meningitis after craniotomy: role of antibiotic prophylaxis. Neurosurgery 2008; 62 Suppl 2: 532-9.
  52. McClelland S, III, Hall WA. Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures. Clin Infect Dis 2007; 45: 55-9.
  53. Aucoin PJ, Kotilainen HR, Gantz NM, Davidson R, Kellogg P, Stone B. Intracranial pressure monitors. Epidemiologic study of risk factors and infections. Am J Med 1986; 80: 369-76.
  54. Kourbeti IS, Jacobs AV, Koslow M, Karabetsos D, Holzman RS. Risk factors associated with postcraniotomy meningitis. Neurosurgery 2007; 60: 317-25.
  55. Federico G, Tumbarello M, Spanu T et al. Risk factors and prognostic indicators of bacterial meningitis in a cohort of 3580 postneurosurgical patients. Scand J Infect Dis 2001; 33: 533-7.
  56. Wang KW, Chang WN, Huang CR et al. Post-neurosurgical nosocomial bacterial meningitis in adults: microbiology, clinical features, and outcomes. J Clin Neurosci 2005; 12: 647-50.
  57. Zarrouk V, Vassor I, Bert F et al. Evaluation of the management of postoperative aseptic meningitis. Clin Infect Dis 2007; 44: 1555-9.
  58. Baltas I, Tsoulfa S, Sakellariou P, Vogas V, Fylaktakis M, Kondodimou A. Posttraumatic meningitis: bacteriology, hydrocephalus, and outcome. Neurosurgery 1994; 35: 422-6.
  59. Infection in neurosurgery working party of the british society for antimicrobial chemotherapy. The management of neurosurgical patients with postoperative bacterial or aseptic meningitis or external ventricular drain-associated ventriculitis. Infection in Neurosurgery Working Party of the British Society for Antimicrobial Chemotherapy. Br J Neurosurg 2000; 14: 7-12.
  60. Schreffler RT, Schreffler AJ, Wittler RR. Treatment of cerebrospinal fluid shunt infections: a decision analysis. Pediatr Infect Dis J 2002; 21: 632-6.
  61. Kim BN, Peleg AY, Lodise TP et al. Management of meningitis due to antibiotic-resistant Acinetobacter species. Lancet Infect Dis 2009; 9: 245-55.
  62. Pfausler B, Spiss H, Beer R et al. Treatment of staphylococcal ventriculitis associated with external cerebrospinal fluid drains: a prospective randomized trial of intravenous compared with intraventricular vancomycin therapy. J Neurosurg 2003; 98: 1040-4.
  63. Beller AJ, Sahar A, Praiss I. Brain abscess. Review of 89 cases over a period of 30 years. J Neurol Neurosurg Psychiatry 1973; 36: 757-68.
  64. Berlit P, Fedel C, Tornow K, Schmiedek P. [Bacterial brain abscess--experiences with 67 patients]. Fortschr Neurol Psychiatr 1996; 64: 297-306.
  65. Carpenter J, Stapleton S, Holliman R. Retrospective analysis of 49 cases of brain abscess and review of the literature. Eur J Clin Microbiol Infect Dis 2007; 26: 1-11.
  66. Hakan T, Ceran N, Erdem I, Berkman MZ, Goktas P. Bacterial brain abscesses: an evaluation of 96 cases. J Infect 2006; 52: 359-66.
  67. Tattevin P, Bruneel F, Clair B et al. Bacterial brain abscesses: a retrospective study of 94 patients admitted to an intensive care unit (1980 to 1999). Am J Med 2003; 115: 143-6.
  68. Smith SJ, Ughratdar I, MacArthur DC. Never go to sleep on undrained pus: a retrospective review of surgery for intraparenchymal cerebral abscess. Br J Neurosurg 2009; 23: 412-7.
  69. Al Masalma M, Armougom F, Scheld WM et al. The expansion of the microbiological spectrum of brain abscesses with use of multiple 16S ribosomal DNA sequencing. Clin Infect Dis 2009; 48: 1169-78.
  70. de Lastours V, Kalamarides M, Leflon V et al. Optimization of bacterial diagnosis yield after needle aspiration in immunocompetent adults with brain abscesses. Neurosurgery 2008; 63: 362-7.
  71. Cavusoglu H, Kaya RA, Turkmenoglu ON, Colak I, Aydin Y. Brain abscess: analysis of results in a series of 51 patients with a combined surgical and medical approach during an 11-year period. Neurosurg Focus 2008; 24: E9.
  72. Goodkin HP, Harper MB, Pomeroy SL. Intracerebral abscess in children: historical trends at Children's Hospital Boston. Pediatrics 2004; 113: 1765-70.
  73. Le Moal G, Landron C, Grollier G et al. Characteristics of brain abscess with isolation of anaerobic bacteria. Scand J Infect Dis 2003; 35: 318-21.
  74. Sennaroglu L, Sozeri B. Otogenic brain abscess: review of 41 cases. Otolaryngol Head Neck Surg 2000; 123: 751-5.
  75. Barlas O, Sencer A, Erkan K, Eraksoy H, Sencer S, Bayindir C. Stereotactic surgery in the management of brain abscess. Surg Neurol 1999; 52: 404-10.
  76. Mamelak AN, Mampalam TJ, Obana WG, Rosenblum ML. Improved management of multiple brain abscesses: a combined surgical and medical approach. Neurosurgery 1995; 36: 76-85.
  77. O'Donoghue MA, Green HT, Shaw MD. Cerebral abscess on Merseyside 1980-1988. J Infect 1992; 25: 163-72.
  78. Tekkok IH, Erbengi A. Management of brain abscess in children: review of 130 cases over a period of 21 years. Childs Nerv Syst 1992; 8: 411-6.
  79. Renier D, Flandin C, Hirsch E, Hirsch JF. Brain abscesses in neonates. A study of 30 cases. J Neurosurg 1988; 69: 877-82.
  80. Chun CH, Johnson JD, Hofstetter M, Raff MJ. Brain abscess. A study of 45 consecutive cases. Medicine (Baltimore) 1986; 65: 415-31.
  81. Brook I. Bacteriology of intracranial abscess in children. J Neurosurg 1981; 54: 484-8.
  82. Shahzad K, Hamid MH, Khan MA, Malik N, Maqbool S. Brain abscess in children. J Coll Physicians Surg Pak 2005; 15: 609-11.
  83. de Louvois, ., Gortavai P, Hurley R. Bacteriology of abscesses of the central nervous system: a multicentre prospective study. Br Med J 1977; 2: 981-4.
  84. Jansson AK, Enblad P, Sjolin J. Efficacy and safety of cefotaxime in combination with metronidazole for empirical treatment of brain abscess in clinical practice: a retrospective study of 66 consecutive cases. Eur J Clin Microbiol Infect Dis 2004; 23: 7-14.
  85. Bartt R. Listeria and atypical presentations of Listeria in the central nervous system. Semin Neurol 2000; 20: 361-73.
  86. Roche M, Humphreys H, Smyth E et al. A twelve-year review of central nervous system bacterial abscesses; presentation and aetiology. Clin Microbiol Infect 2003; 9: 803-9.
  87. Mampalam TJ, Rosenblum ML. Trends in the management of bacterial brain abscesses: a review of 102 cases over 17 years. Neurosurgery 1988; 23: 451-8.
  88. Bagdatoglu H, Ildan F, Cetinalp E et al. The clinical presentation of intracranial abscesses. A study of seventy-eight cases. J Neurosurg Sci 1992; 36: 139-43.
  89. Miller ES, Dias PS, Uttley D. CT scanning in the management of intracranial abscess: a review of 100 cases. Br J Neurosurg 1988; 2: 439-46.
  90. Tonon E, Scotton PG, Gallucci M, Vaglia A. Brain abscess: clinical aspects of 100 patients. Int J Infect Dis 2006; 10: 103-9.
  91. Gomez J, Garcia-Vazquez E, Martinez PM et al. [Brain abscess. The experience of 30 years]. Med Clin (Barc ) 2008; 130: 736-9.
  92. Lunardi P, Acqui M, Ferrante L, Mastronardi L, Fortuna A. Non-traumatic brain abscess. Neurosurg Rev 1993; 16: 189-96.
  93. Nicolosi A, Hauser WA, Musicco M, Kurland LT. Incidence and prognosis of brain abscess in a defined population: Olmsted County, Minnesota, 1935-1981. Neuroepidemiology 1991; 10: 122-31.
  94. Richards J, Sisson PR, Hickman JE, Ingham HR, Selkon JB. Microbiology, chemotherapy and mortality of brain abscess in Newcastle-upon-Tyne between 1979 and 1988. Scand J Infect Dis 1990; 22: 511-8.
  95. Svanteson B, Nordstrom CH, Rausing A. Non-traumatic brain abscess. Epidemiology, clinical symptoms and therapeutic results. Acta Neurochir (Wien ) 1988; 94: 57-65.
  96. Danziger A, Price H, Schechter MM. An analysis of 113 intracranial infections. Neuroradiology 1980; 19: 31-4.
  97. Hilmani S, Riyahi S, Ibahioin K, Naja A, El KA, El AA. [Brain abscess (80 cases)]. Neurochirurgie 2009; 55: 40-4.
  98. Morgan H, Wood MW, Murphey F. Experience with 88 consecutive cases of brain abscess. J Neurosurg 1973; 38: 698-704.
  99. Carey ME, Chou SN, French LA. Long-term neurological residua in patients surviving brain abscess with surgery. J Neurosurg 1971; 34: 652-6.
  100. Rish BL, Caveness WF, Dillon JD, Kistler JP, Mohr JP, Weiss GH. Analysis of brain abscess after penetrating craniocerebral injuries in Vietnam. Neurosurgery 1981; 9: 535-41.
  101. Gruszkiewicz J, Doron Y, Peyser E, Borovich B, Schachter J, Front D. Brain abscess and its surgical management. Surg Neurol 1982; 18: 7-17.
  102. Bradley PJ, Manning KP, Shaw MD. Brain abscess secondary to otitis media. J Laryngol Otol 1984; 98: 1185-91.
  103. Ersahin Y, Mutluer S, Guzelbag E. Brain abscess in infants and children. Childs Nerv Syst 1994; 10: 1859.
  104. Schliamser SE, Backman K, Norrby SR. Intracranial abscesses in adults: an analysis of 54 consecutive cases. Scand J Infect Dis 1988; 20: 1-9.
  105. Mathisen GE, Meyer RD, George WL, Citron DM, Finegold SM. Brain abscess and cerebritis. Rev Infect Dis 1984; 6 Suppl 1: S101-S106.
  106. Shaw MD, Russell JA. Cerebellar abscess. A review of 47 cases. J Neurol Neurosurg Psychiatry 1975; 38: 429-35.
  107. Nielsen H. Cerebral abscess in children. Neuropediatrics 1983; 14: 76-80.
  108. Hirsch JF, Roux FX, Sainte-Rose C, Renier D, Pierre-Kahn A. Brain abscess in childhood. A study of 34 cases treated by puncture and antibiotics. Childs Brain 1983; 10: 251-65.
  109. Moss SD, McLone DG, Arditi M, Yogev R. Pediatric cerebral abscess. Pediatr Neurosci 1988; 14: 291-6.
  110. Fischer EG, McLennan JE, Suzuki Y. Cerebral abscess in children. Am J Dis Child 1981; 135: 746-9.
  111. Dohrmann PJ, Elrick WL. Observations on brain abscess. Review of 28 cases. Med J Aust 1982; 2: 81-3.
  112. Sharma R, Mohandas K, Cooke RP. Intracranial abscesses: changes in epidemiology and management over five decades in Merseyside. Infection 2009; 37: 39-43.
  113. van Alphen HA, Dreissen JJ. Brain abscess and subdural empyema. Factors influencing mortality and results of various surgical techniques. J Neurol Neurosurg Psychiatry 1976; 39: 481-90.
  114. Al MM, Armougom F, Scheld WM et al. The expansion of the microbiological spectrum of brain abscesses with use of multiple 16S ribosomal DNA sequencing. Clin Infect Dis 2009; 48: 1169-78.
  115. de LJ, Gortvai P, Hurley R. Antibiotic treatment of abscesses of the central nervous system. Br Med J 1977; 2: 985-7.
  116. Mayhall CG, Archer NH, Lamb VA et al. Ventriculostomy-related infections. A prospective epidemiologic study. N Engl J Med 1984; 310: 553-9.
  117. Stenager E, Gerner-Smidt P, Kock-Jensen C. Ventriculostomy-related infections--an epidemiological study. Acta Neurochir (Wien ) 1986; 83: 20-3.
  118. Ohrstrom JK, Skou JK, Ejlertsen T, Kosteljanetz M. Infected ventriculostomy: bacteriology and treatment. Acta Neurochir (Wien ) 1989; 100: 67-9.
  119. Coplin WM, Avellino AM, Kim DK, Winn HR, Grady MS. Bacterial meningitis associated with lumbar drains: a retrospective cohort study. J Neurol Neurosurg Psychiatry 1999; 67: 468-73.
  120. Lyke KE, Obasanjo OO, Williams MA, O'Brien M, Chotani R, Perl TM. Ventriculitis complicating use of intraventricular catheters in adult neurosurgical patients. Clin Infect Dis 2001; 33: 2028-33.
  121. Wong GK, Poon WS, Wai S, Yu LM, Lyon D, Lam JM. Failure of regular external ventricular drain exchange to reduce cerebrospinal fluid infection: result of a randomised controlled trial. J Neurol Neurosurg Psychiatry 2002; 73: 759-61.
  122. Pfisterer W, Muhlbauer M, Czech T, Reinprecht A. Early diagnosis of external ventricular drainage infection: results of a prospective study. J Neurol Neurosurg Psychiatry 2003; 74: 929-32.
  123. Park P, Garton HJ, Kocan MJ, Thompson BG. Risk of infection with prolonged ventricular catheterization. Neurosurgery 2004; 55: 594-9.
  124. Arabi Y, Memish ZA, Balkhy HH et al. Ventriculostomy-associated infections: incidence and risk factors. Am J Infect Control 2005; 33: 137-43.
  125. Leverstein-van Hall MA, Hopmans TE, van der Sprenkel JW et al. A bundle approach to reduce the incidence of external ventricular and lumbar drain-related infections. J Neurosurg 2010; 112: 345-53.
  126. Schade RP, Schinkel J, Visser LG, Van Dijk JM, Voormolen JH, Kuijper EJ. Bacterial meningitis caused by the use of ventricular or lumbar cerebrospinal fluid catheters. J Neurosurg 2005; 102: 229-34.
  127. Walters BC, Hoffman HJ, Hendrick EB, Humphreys RP. Cerebrospinal fluid shunt infection. Influences on initial management and subsequent outcome. J Neurosurg 1984; 60: 1014-21.
  128. Filka J, Huttova M, Tuharsky J, Sagat T, Kralinsky K, Krcmery V, Jr. Nosocomial meningitis in children after ventriculoperitoneal shunt insertion. Acta Paediatr 1999; 88: 576-8.
  129. Kestle JR, Garton HJ, Whitehead WE et al. Management of shunt infections: a multicenter pilot study. J Neurosurg 2006; 105: 177-81.
  130. Sacar S, Turgut H, Toprak S et al. A retrospective study of central nervous system shunt infections diagnosed in a university hospital during a 4-year period. BMC Infect Dis 2006; 6:43.: 43.
  131. Aucoin PJ, Kotilainen HR, Gantz NM, Davidson R, Kellogg P, Stone B. Intracranial pressure monitors. Epidemiologic study of risk factors and infections. Am J Med 1986; 80: 369-76.
  132. Kourbeti IS, Jacobs AV, Koslow M, Karabetsos D, Holzman RS. Risk factors associated with postcraniotomy meningitis. Neurosurgery 2007; 60: 317-25.
  133. Federico G, Tumbarello M, Spanu T et al. Risk factors and prognostic indicators of bacterial meningitis in a cohort of 3580 postneurosurgical patients. Scand J Infect Dis 2001; 33: 533-7.
  134. Wang KW, Chang WN, Huang CR et al. Post-neurosurgical nosocomial bacterial meningitis in adults: microbiology, clinical features, and outcomes. J Clin Neurosci 2005; 12: 647-50.
  135. Zarrouk V, Vassor I, Bert F et al. Evaluation of the management of postoperative aseptic meningitis. Clin Infect Dis 2007; 44: 1555-9.

Autorisatiedatum en geldigheid

Laatst beoordeeld  : 01-01-2012

Laatst geautoriseerd  : 01-01-2012

Initiatief en autorisatie

Initiatief:
  • Stichting Werkgroep Antibioticabeleid
Geautoriseerd door:
  • Nederlandse Vereniging voor Kindergeneeskunde
  • Nederlandse Vereniging voor Medische Microbiologie
  • Nederlandse Vereniging voor Neurochirurgie
  • Nederlandse Vereniging voor Neurologie

Algemene gegevens

The Dutch Working Party on Antibiotic Policy (SWAB; Stichting Werkgroep Antibiotica Beleid), established by the Dutch Society for Infectious Diseases (VIZ), the Dutch Society of Medical Microbiology (NVMM) and the Dutch Society for Hospital Pharmacists (NVZA), develops evidence-based guidelines for the use of antibiotics in hospitalized patients in order to optimize the quality of prescribing, thus, contributing to the containment of antimicrobial drug costs and resistance. By means of the development of national guidelines, SWAB offers local antibiotic and formulary committees a guideline for the development of their own, local antibiotic policy.  These are the first SWAB guidelines on bacterial central nervous system infections. It is developed according to the Evidence Based Guideline Development method (EBRO; www.cbo.nl). The AGREE criteria

(www.agreecollaboration.org) provided a structured framework both for the development and the assessment of the draft guideline. 

 

Relationship between the SWAB Guidelines and the 2012 Guidelines on Meningitis by the Dutch Society for Neurology (Nederlandse Vereniging voor Neurologie)

The SWAB guidelines cover the antimicrobial therapy in children and adults with bacterial meningitis, brain abscesses and tuberculous meningitis. They do not cover other treatment components of bacterial meningitis, such as corticosteroids, osmotic agents and anticoagulants.2 This is discussed extensively in the 2012 guidelines by the Dutch Society for Neurology (Nederlandse Vereniging voor Neurologie). The Nederlandse Vereniging voor Neurologie guidelines adopted the SWAB guidelines on meningitis to be the treatment part of their meningitis guidelines.

Doel en doelgroep

Core issues on cryptococcal meningitis are extensively discussed in the 2008 SWAB guidelines on fungal infections. Diagnostics for bacterial meningitis are briefly discussed in the introduction, but not systematically reviewed in these guidelines. Encephalitis falls outside the scope of these guidelines.

For this guideline we made a distinction based on the setting in which bacterial meningitis was acquired: community-acquired versus nosocomial. Further, we provide recommendations for empirical antimicrobial therapy for clinical subgroups of bacterial meningitis patients. The choice of initial antimicrobial therapy for these subgroups is based on the bacteria most commonly causing the disease, taking into account the patient’s age and clinical setting, and patterns of antimicrobial susceptibility. After the results of culture and susceptibility testing have become available, antimicrobial therapy can be modified for optimal treatment. 

Samenstelling werkgroep

Preparatory Committee: Dr. M.C. Brouwer, Drs. S.G.B. Heckenberg, Dr. G.T.J. van Well (Nederlandse Vereniging voor Kindergeneeskunde), Dr. A. Brouwer (Vereniging voor Infectieziekten), Dr. E.J. Delwel (Nederlandse Vereniging voor Neurochirurgie), Dr. L. Spanjaard (Nederlandse Vereniging voor Medisch Microbiologie), Prof. dr. D. van de Beek (Nederlandse Vereniging voor Neurologie), Prof. dr. J.M. Prins (SWAB).

Methode ontwikkeling

Evidence based

Werkwijze

Twelve key questions were formulated concerning the antibiotic treatment of bacterial central nervous system infections. Using several data sources (see data sources) conclusions were drawn, with their specific level of evidence, according to the CBO grading system adopted by SWAB (Table 1).1

Subsequently, specific recommendations were formulated. Each key question will be answered in a separate chapter. 

 

Table 1a

Methodological quality of individual studies.1

 

 

Intervention

Etiology, prognosis

A1 

Systematic review of at least two independent A2-level studies 

A2 

Randomised Controlled Trial (RCT) of sufficient methodological quality and power 

Prospective cohort study with sufficient power and with adequate confounding corrections 

Comparative Study lacking the same quality

as mentioned at A2 (including patientcontrol and cohort studies) 

Prospective cohort study lacking the same quality as mentioned at A2, retrospective cohort study or patient-control study 

Non-comparative study 

Expert opinion 

 

Table 1b

Level of evidence of conclusions

 

 

Conclusions based on 

Study of level A1 or at least two independent studies of level A2 

One study of level A2 or at least two independent studies of level B 

One study of level B or C 

Expert opinion 

Zoekverantwoording

Zoekacties zijn opvraagbaar. Neem hiervoor contact op met de Richtlijnendatabase.

Volgende:
Nosocomiale bacteriële meningitis