Management of bacterial central nervous system infections

M C Brouwer, D van de Beek
Handbook of Clinical Neurology 2017, 140: 349-364
Bacterial infections of the central nervous system present as a medical emergency, thus requiring rapid diagnosis and immediate treatment. The most prevalent bacterial infections seen in the intensive care unit can be summarized as acute bacterial meningitis, subdural empyema, intracerebral abscess, and ventriculitis, which all commonly involve the brain parenchyma. The infections can either be community-acquired or hospital-acquired, e.g., after neurosurgical intervention, as a complication of severe neurotrauma or related to indwelling cerebrospinal fluid drains. Community-acquired bacterial meningitis is most commonly caused by the pneumococcus (Streptococcus pneumoniae) and meningococcus (Neisseria meningtidis), and is often complicated by hearing loss, cerebrovascular complications, and seizures. Brain abscesses are frequently associated with contiguous or metastatic foci of infection such as otitis, sinusitis, pneumonia, or endocarditis which need to be detected and treated early during disease course. Despite optimal treatment, many patients are at risk for both major systemic and neurologic complications, leading to a substantial mortality and risk of major disability in survivors. Empiric treatment depends on regional antibiotic resistance patterns of common pathogens. For subdural empyema and brain abscesses, neurosurgical drainage of the infection is required alongside prolonged antibiotic treatment.

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