SFGH Guidelines for
treating suspected or confirmed EVD infection
- CSF obtained from EVD is
consistent with infection based on cell count, glucose, protein. If the
Gram stain is negative for organisms, start cefepime 2 g IV q 8 hr and
vancomycin 15 mg/kg IV q 12 hr. If the Gram stain is positive for
organisms, start directed therapy (please consult ID).
- If the CSF culture is
negative, usually antibiotics can be stopped. If the CSF culture is
positive, tailor IV antibiotics appropriately and go to steps below (please
consult ID, if not done previously).
- If the EVD can be
removed safely, remove the EVD. Continue intravenous antibiotics and
monitor clinically. If patient responds well, continue intravenous
antibiotics for one week. If the patient does not respond well, discuss
re-sampling of CSF and possible use of intrathecal antibiotics depending on
CSF results. If the EVD cannot be removed safely, ideally it should be
replaced on the opposite side. Continue intravenous antibiotics. If the
patient responds well and the EVD remains in place, continue intravenous
antibiotics for minimum of one week.
- Will need to re-sample
CSF to document clearance. If the patient does not respond well within 48 –
72 hours, low threshold to use intrathecal antibiotics.
See flow diagram below.