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2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis
Allan R Tunkel1, Rodrigo Hasbun2, Adarsh Bhimraj3
1Department of Internal Medicine-Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Insights
This guideline provides expert recommendations for managing healthcare-associated ventriculitis and meningitis, crucial for clinicians caring for neurosurgical patients. It addresses infections linked to devices and procedures, aiming to improve patient outcomes.
Area of Science:
- Infectious Diseases
- Neurosurgery
- Critical Care Medicine
Background:
- Healthcare-associated ventriculitis and meningitis are serious infections often linked to neurosurgical procedures and devices.
- Management requires specialized knowledge due to complex patient populations and limited high-quality clinical data.
Purpose of the Study:
- To develop evidence-based guidelines for the diagnosis and management of healthcare-associated ventriculitis and meningitis.
- To provide practical recommendations for clinicians caring for patients with these challenging infections.
Main Methods:
- A panel of 10 experts in infectious diseases, neurology, neurosurgery, and neurocritical care was convened.
- Systematic literature reviews, evaluation of evidence, and expert consensus were used to formulate recommendations.
- Guidelines were developed for specific patient populations and procedures, including CSF shunts, drains, and neurosurgical hardware implantation.
Main Results:
- Recommendations cover various aspects of managing healthcare-associated ventriculitis and meningitis.
- Strength of recommendation and quality of evidence were assessed for each guideline.
- Many recommendations are based on expert opinion due to a lack of robust clinical trial data.
Conclusions:
- These guidelines offer a practical framework for clinicians managing healthcare-associated ventriculitis and meningitis.
- The guidelines aim to standardize care and improve outcomes for patients with these infections.
- Further research is needed to generate more rigorous clinical data for evidence-based recommendations.
Abstract:
The Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee collaborated with partner organizations to convene a panel of 10 experts on healthcare-associated ventriculitis and meningitis. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with healthcare-associated ventriculitis and meningitis (American Academy of Neurology, American Association of Neurological Surgeons, and Neurocritical Care Society). The panel reviewed articles based on literature reviews, review articles and book chapters, evaluated the evidence and drafted recommendations. Questions were reviewed and approved by panel members. Subcategories were included for some questions based on specific populations of patients who may develop healthcare-associated ventriculitis and meningitis after the following procedures or situations: cerebrospinal fluid shunts, cerebrospinal fluid drains, implantation of intrathecal infusion pumps, implantation of deep brain stimulation hardware, and general neurosurgery and head trauma. Recommendations were followed by the strength of the recommendation and the quality of the evidence supporting the recommendation. Many recommendations, however, were based on expert opinion because rigorous clinical data are not available. These guidelines represent a practical and useful approach to assist practicing clinicians in the management of these challenging infections.
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