Key concepts

© 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.

01 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.

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 (such as vaccination and suppressive therapy) to prevent future infections.

O1 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.

® IV therapy is administered for the full course of therapy for CNS infections to ensure adequate CSF penetration throughout the course of treatment.

Empirical 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.

Empirical antimicrobial therapy should be modified on the basis of laboratory data and clinical response.

® Close contacts of patients with CNS infections should be evaluated for possible antimicrobial prophylaxis.

O 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).

The term CNS infections describes a variety of infections involving the brain and spinal cord and associated tissues, fluids, and membranes, including meningitis, encephalitis, brain abscess, shunt infections, and postoperative infections (see Glossary). 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 remains greater than 20%, and at least 10% to 30% of survivors are afflicted with neurologic impairment, including hearing loss, hemiparesis, and learn-

ing disabilities. Antimicrobial therapy and preventive vaccines have revolutionized management and improved outcomes of bacterial meningitis and other CNS infections dramatically.

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