Infectious intracranial complications in the neuro-ICU patient population

Abstract

Purpose of review: To provide an overview of infectious intracranial complications secondary to invasive procedures or trauma in the neuro-ICU patient population. Nosocomial infections of the central nervous system are a serious complication contributing to morbidity, prolonged length of stay in the ICU and/or hospital, and mortality of neurocritical care patients.

Recent findings: Any type of neurosurgical interventions, specifically ventriculostomy/external ventricular drainage, constitutes a major risk factor for infectious intracranial complications. Other predisposing factors are comorbidities with immunocompromised state and the presence of a distant focus of infection. The emergence of multiresistant pathogens adds to the complexity of the management of infectious intracranial complications. In recent years, several antimicrobial agents suitable for the treatment of nosocomial central nervous system infections have been extensively studied with respect to pharmacodynamics and pharmacokinetics in serum and - of special importance in the neurocritical care setting - cerebrospinal fluid.

Summary: Despite recent advances in prevention and treatment, the management of nosocomial intracranial infections still poses a challenge to the neuro-ICU specialist and must consider timely diagnosis and prompt initiation of appropriate antibiotic therapy. This review focuses on the definition, epidemiology, clinical features, and therapeutical approach to this distinct complication of neurocritical care.