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A Practical Approach to Antimicrobial Stewardship for Central Nervous System Infections

Facer, Evan E. DO*; Newland, Jason G. MD, MEd*. A Practical Approach to Antimicrobial Stewardship for Central Nervous System Infections. The Pediatric Infectious Disease Journal 44(1):p e7-e10, January 2025. | DOI: 10.1097/INF.0000000000004518

Central nervous system (CNS) infections, including meningitis, brain abscesses, and ventriculoperitoneal shunt-related infections, present considerable opportunity for antimicrobial stewardship guidance. However, rigorous clinical research studies evaluating shortened antimicrobial durations and clinical outcomes are lacking. Potential challenges of pursuing clinical trials evaluating shortened antibiotic duration for CNS infections include the rarity of these infections and the risk for clinical failure resulting in significant neurologic sequelae. Additionally, while cerebrospinal fluid (CSF) indices such as cell count, glucose, and protein along with culture remain the most definitive way to diagnose bacterial CNS infection, few other diagnostic tests remain aside from sampling of the infected space, which is not always clinically possible. Based on the specific clinical presentation and location of infection, pathogens of interest may vary. Moreover, CNS infection in the setting of hardware requires important therapeutic considerations, including the potential for colonization of difficult-to-treat bacteria or the need for the removal of the device. Because of this, it is imperative that antimicrobial stewardship principles—optimal antimicrobial agent prescribed at the best dose, for the correct duration—are incorporated in the management of these serious infections. 

Consulte o artigo aqui: https://journals.lww.com/pidj/fulltext/2025/01000/a_practical_approach_to_antimicrobial_stewardship.20.aspx

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