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Journal of Pharmacy Practice, Vol. 18, No. 1, 25-41 (2005)
DOI: 10.1177/0897190004273604
© 2005 SAGE Publications

Central Nervous System Infections in the Critically Ill

John J. Lewin, III, PharmD, BCPS

The Johns Hopkins Hospital, 600 North Wolfe St., Carnegie 180, Baltimore, MD 21287-6180;jlewin3{at}jhmi.edu

Marc Lapointe, BS, PharmD, BCPS, BCNSP

College of Pharmacy, Department of Pharmacy and Clinical Sciences, College of Medicine, Department of Neurological Surgery, Medical University of South Carolina, Charleston.

Wendy C. Ziai, MD

Division of Neurosciences Critical Care, The Johns Hopkins Hospital, Baltimore.

Central nervous system (CNS) infections are frequently encountered in the intensive care unit setting and are a significant source of morbidity and mortality. The constantly changing trends in microbial resistance, as well as the pharmacokinetic difficulties in providing effective concentrations of antimicrobials at the site of infection represent a unique challenge to clinicians. Achievement of a successful outcome in patientswith CNS infections is reliant on eradication of the offending pathogen and management of any neurologic complications. This requires an anatomic and physiologic understanding of the different types of CNS infection, diagnostic strategies, associated complications, causative organisms, and the principles that govern drug distribution into the CNS. This article serves as a review of the epidemiology, pathophysiology, diagnosis, and treatment options for a variety of CNS infections, with a focus on those commonly encountered in an intensive care setting.

Key Words: Meningitis • encephalitis • ventriculitis • abscess • subdural empyema


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