The management of neurosurgical patients with postoperative bacterial or aseptic meningitis or external ventricular drain-associated ventriculitis

This article is dedicated to the management of neurosurgical patients who d evelop postoperative meningitis or external ventricular drain (EVD)-related ventriculitis. Postoperative meningitis is either bacterial or aseptic, th e latter occurring more commonly. However, owing to difficulties associated with distinguishing between the two processes, all patients with the clini cal and laboratory features of postoperative meningitis should receive empi rical antibiotic therapy; if a cultured sample of CSF is sterile after incu bation for 3 days, the antibiotics can be discontinued. Patients with confi rmed bacterial meningitis should be treated with one of the organism-specif ic regimens provided. Also provided are recommendations for the management of patients with EVD-related ventriculitis and a strategy for preventing sh unt infections in patients with EVDs who undergo implantation of CSF shunts .