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REVIEW ARTICLE
Year : 2014  |  Volume : 3  |  Issue : 2  |  Page : 106-113

Central nervous system infections in the intensive care unit


1 Department of Neurology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
2 Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences, Tirupati, India

Correspondence Address:
B Vengamma
Director, Senior Professor and Head, Department of Neurology, Sri Venkateswara Institute of Medical Sciences, Tirupati
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.15380/2277-5706.JCSR.13.044

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Neurological infections constitute an uncommon, but important aetiological cause requiring admission to an intensive care unit (ICU). In addition, health-care associated neurological infections may develop in critically ill patients admitted to an ICU for other indications. Central nervous system infections can develop as complications in ICU patients including post-operative neurosurgical patients. While bacterial infections are the most common cause, mycobacterial and fungal infections are also frequently encountered. Delay in institution of specific treatment is considered to be the single most important poor prognostic factor. Empirical antibiotic therapy must be initiated while awaiting specific culture and sensitivity results. Choice of empirical antimicrobial therapy should take into consideration the most likely pathogens involved, locally prevalent drug-resistance patterns, underlying predisposing, co-morbid conditions, and other factors, such as age, immune status. Further, the antibiotic should adequately penetrate the blood-brain and blood- cerebrospinal fluid barriers. The presence of a focal collection of pus warrants immediate surgical drainage. Following strict aseptic precautions during surgery, hand-hygiene and care of catheters, devices constitute important preventive measures. A high index of clinical suspicion and aggressive efforts at identification of aetiological cause and early institution of specific treatment in patients with neurological infections can be life saving.


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