Post surgical ventriculitis/meningitis

Samples should be obtained prior to antibiotic initiation.

Removal of infected shunt/hardware is key.

Addition of intrathecal antibiotics should be strongly considered. The prescription and administration of intrathecal antibiotics can only be undertaken by appropriately trained staff on the local intrathecal register (see Neurology and Critical Care intranet pages).

For the management of ventriculitis in Critical Care, see guideline on the Critical Care intranet page

Recommended investigations

Blood culture X2 sets (10mls in each bottle)

CSF sampling for microscopy and culture

Antibiotic recommendation

Recommended antibiotic

Vancomycin IV (use NHS Lothian Calculator on AMT intranet page); aim trough levels 15-20mg/L

PLUS

Ceftazidime 2g IV 8 hourly
Severe penicillin allergy

Vancomycin IV (use NHS Lothian Calculator on AMT intranet page); aim trough levels 15-20mg/L

PLUS

Ciprofloxacin 400mg IV 8 hourly*

*Avoid fluoroquinolones if taking steroids and the elderly. Review MHRA Quinolone Warning before prescribing. If an alternative agent is required please contact microbiology.

Recommended total duration

Discuss with microbiology and neurosurgery

10-14 days. Gram negative infection may be extended to 21 days.

Notes

Common organisms: Staph aureus, coagulase negative Staphylococci (especially S. epidermidis) and Gram-negative bacilli (including Pseudomonas spp).