Postoperative Intracranial Infection Treatment
Intracranial Infection Treatment
Postoperative intracranial infections are serious complications that may occur after craniotomy, CSF diversion procedures, or penetrating trauma. Prompt diagnosis and targeted treatment are critical to avoid neurological deterioration or death.
1. Common Postoperative CNS Infections
- Post-craniotomy meningitis (often without CSF leak)
- Subdural or epidural empyema
- Brain abscess at surgical site
- Ventriculitis (commonly related to EVD or shunt)
- Surgical site infection (SSI) with bone flap involvement
2. Likely Pathogens
| Setting / Device | Common Microorganisms |
|---|---|
| Craniotomy | *Staphylococcus aureus*, *S. epidermidis*, Gram-negatives |
| CSF shunt / EVD | Coagulase-negative staph, *Pseudomonas*, *Acinetobacter* |
| Delayed SSI | Anaerobes, *Propionibacterium acnes* |
3. Empirical Antibiotic Therapy
Start after cultures are obtained, unless the patient is unstable.
- Vancomycin (MRSA coverage) +
- Cefepime or Meropenem (broad-spectrum Gram-negative including *Pseudomonas*)
- Consider Metronidazole if anaerobic coverage needed
4. Targeted Therapy
Adjust based on CSF, wound, or bone flap cultures:
- MSSA → Oxacillin or Cefazolin
- MRSA → Vancomycin or Linezolid
- Pseudomonas → Ceftazidime, Cefepime, Meropenem
- Coagulase-negative staph → Vancomycin
5. Surgical Management
- Evacuation of abscess/empyema if ≥2.5 cm or causing mass effect
- Removal of bone flap if osteomyelitis suspected
- Shunt removal / EVD replacement in infected devices
- Debridement of infected tissue
6. Duration of Treatment
- Meningitis/Ventriculitis: 10–14 days (if device removed)
- Brain abscess: 4–6 weeks
- Osteomyelitis of skull: ≥6 weeks, often with bone flap removal
7. Supportive Measures
- Seizure prophylaxis if cortical irritation suspected
- ICP control: Mannitol, hypertonic saline, external ventricular drainage
- Monitoring: Serial imaging, inflammatory markers (CRP, procalcitonin), neurological exams
Notes
- Always assess for CSF leak, which predisposes to infection.
- Prophylactic antibiotics perioperatively reduce, but do not eliminate, risk.
- Multidisciplinary management is essential (Neurosurgery + ID + ICU).