Management of CNS-Related Infection

Central nervous system (CNS) infection is a serious complication to head trauma or to invasive procedures, most often following implantation of an external ventricular drain (EVD). The etiological agents associated with these infections (e.g. resistant gram-negative bacilli and staphylococci) are different to those found in community-acquired meningitis, and the pathogenic mechanisms are different. The diagnosis may be difficult to establish as both clinical presentation and CSF abnormalities related to trauma and surgery in these patients confound the usual diagnostics. This chapter focuses mainly on management of drain-related CNS infections, as these require highly specialised knowledge. This chapter also suggests a general empirical treatment strategy for CNS infection in the TBI patient.