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Antibiotics
Special Issues
Antimicrobial Treatment and Management of Central Nervous System Infections
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Antimicrobial Treatment and Management of Central Nervous System Infections

A special issue of Antibiotics (ISSN 2079-6382).

Deadline for manuscript submissions: 15 May 2025 | Viewed by 6737

Special Issue Editors

Dr. Liana Signorini

E-Mail Website
Guest Editor
Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
Interests: antibiotic resistance; antimicrobial stewardship; ICU infections; endocarditis; CNS infections
Dr. Angelo Pan

E-Mail Website
Guest Editor
UOC Malattie Infettive e Tropicali, ASST Cremona, 26100 Cremona, Italy
Interests: antibiotic resistance; antimicrobial stewardship; infection control; CNS infections

Special Issue Information

Dear Colleagues,

The central nervous system (CNS) might be considered a sanctuary for infections. Transport of fluid and solutes is tightly controlled within the CNS, as the entry of drugs into the cerebrospinal fluid (CSF) is governed by molecular size, lipophilicity, plasma protein binding and their affinity to transport systems at the blood–brain barrier (BBB). For these reasons, CNS infections, especially in hospital settings, are a therapeutic challenge for Specialists of Infectious Diseases (IDs).

In the literature, only a few papers are available regarding therapeutic regimens for hospital-acquired (HA) CNS infections, especially in terms of requiring antibiotics combinations or therapy duration. In the absence of updated guidelines, there is little experience in the use of novel antibiotics in difficult-to-treat pathogens which are increasingly responsible for nosocomial infections in Neurosurgery Departments.

This Special Issue seeks manuscript submissions that deepen our understanding of the treatment and management of CNS infections and broaden our knowledge in this challenging field, in particular regarding HA Infections. Submissions regarding pharmacokinetic studies of novel antibiotics in HA CNS infections are especially encouraged.

Acknowledgment: Silvia Lorenzotti and Barbara Saccani will be participating in this Special Issue as "Special collaborators". We thank them for their contributions.

Dr. Liana Signorini
Dr. Angelo Pan
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • central nervous system
  • CNS
  • hospital-acquired infection
  • nosocomial
  • neurosurgery
  • external ventricular drainage
  • EVD
  • post-neurosurgical meningitis
  • bacterial colonization

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Published Papers (5 papers)

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14 pages, 1331 KiB  
Article
Risk Assessment and Recommended Approaches to Optimize Infection Control and Antibiotic Stewardship to Reduce External Ventricular Drain Infection: A Single-Center Study
by Jozsef Kelemen, Marton Sztermen, Eva Dakos, Gergely Agocs, Jozsef Budai, Jozsef Katona, Zsuzsanna Szekeressy, Laszlo Sipos, Zoltan Papp, Mate Bata, Janos Karczub, Mate Korompai, Zsuzsanna A. Dunai, Bela Kocsis, Dora Szabo and Lorand Eross
Antibiotics 2024, 13(11), 1093; https://doi.org/10.3390/antibiotics13111093 - 17 Nov 2024
Viewed by 472
Abstract
Background: An external ventricular drain (EVD) is used to release elevated intracranial pressure by draining cerebrospinal fluid (CSF) from the brain’s ventricles. The establishment of an EVD is one of the most commonly performed neurosurgical procedures to treat intracranial pressure in patients. Nevertheless, [...] Read more.
Background: An external ventricular drain (EVD) is used to release elevated intracranial pressure by draining cerebrospinal fluid (CSF) from the brain’s ventricles. The establishment of an EVD is one of the most commonly performed neurosurgical procedures to treat intracranial pressure in patients. Nevertheless, infections are very frequent complications. Identifying the risk factors for EVD-related infections is a key to improving patient safety and outcomes. Methods: We conducted a retrospective, single-center study of patients who underwent EVD implantation between January 2022 and March 2024. Patients were classified into infected and non-infected groups based on their clinical symptoms, as well as laboratory and microbiological results. Patient characteristics and possible risk factors for infection were compared between the two groups. Results: In total, 123 patients treated with 156 EVDs were included in this study, with a mean age of 55.8 (range: 25–84) years. EVD-associated infections were observed in 37 patients (30%). We found no significant association between infection risk and patient characteristics, including gender, primary diagnosis, craniotomy, or immunosuppression. There was no significant difference in terms of EVD insertion, i.e., whether the insertion took place in the operating room (OR) with antibiotic prophylaxis or outside the OR with no periprocedural antibiotic treatment. However, within the intensive care unit (ICU), EVD infection was much lower (13%) if EVD insertion took place in a single-bed room compared to multiple-bed room insertions (34%). Furthermore, there were significant differences in terms of the duration of first EVD (both single and multiple catheterizations) (p < 0.0001) and the total catheterization time (p = 0.0001). Additionally, there was a significant association with patient days in the ICU and EVD catheterization. Conclusions: Revisiting infection control measures is necessary, with special attention to the replacement of EVDs in single-bed ICU rooms, to introduce antibiotic prophylaxis in the ICU. Minimizing unnecessary EVD manipulation during catheterization is crucial in order to decrease the risk of EVD infection. Full article
(This article belongs to the Special Issue Antimicrobial Treatment and Management of Central Nervous System Infections)
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13 pages, 9212 KiB  
Article
Fosfomycin-Containing Regimens for the Treatment of Central Nervous System Infections in a Neonatal Intensive Care Unit: A Case Series Study
by Angelica Lenzi, Barbara Saccani, Marco Di Gregorio, Francesco Rossini, Alessio Sollima, Alice Mulè, Federica Morucci, Silvia Amadasi, Benedetta Fumarola, Paola Antonia Lanza, Silvia Lorenzotti, Evelyn Van Hauwermeiren, Elisa Cavalleri, Roberto Marzollo, Alberto Matteelli, Liana Signorini and Francesco Maria Risso
Antibiotics 2024, 13(7), 667; https://doi.org/10.3390/antibiotics13070667 - 18 Jul 2024
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Abstract
Central nervous system infections are among the most severe infectious conditions in the neonatal period and are still burdened by significant mortality, especially in preterm infants and those with a low birth weight or other comorbidities. In this study, we examined the role [...] Read more.
Central nervous system infections are among the most severe infectious conditions in the neonatal period and are still burdened by significant mortality, especially in preterm infants and those with a low birth weight or other comorbidities. In this study, we examined the role of fosfomycin-containing antibiotic regimens in neonates with central nervous system infections. We included six neonates over a period of five years: four with meningitis and two with cerebral abscesses. All patients underwent fosfomycin therapy after failing first-line antibiotic regimens. Of the six neonates, two died; two developed neurological and psychomotor deficits and two recovered uneventfully. None of the neonates experienced adverse reactions to fosfomycin, confirming the safety of the molecule in this population. In conclusion, the deep penetration in the central nervous system, the unique mechanism of action, the synergy with other antibiotic therapies, and the excellent safety profile all make fosfomycin an attractive drug for the treatment of neonatal central nervous system infections. Full article
(This article belongs to the Special Issue Antimicrobial Treatment and Management of Central Nervous System Infections)
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9 pages, 1391 KiB  
Article
Role of Cefiderocol in Multidrug-Resistant Gram-Negative Central Nervous System Infections: Real Life Experience and State-of-the-Art
by Alessio Sollima, Francesco Rossini, Paola Lanza, Carlo Pallotto, Marianna Meschiari, Ivan Gentile, Roberto Stellini, Angelica Lenzi, Alice Mulé, Francesca Castagna, Silvia Lorenzotti, Silvia Amadasi, Evelyn Van Hauwermeiren, Barbara Saccani, Benedetta Fumarola, Liana Signorini, Francesco Castelli and Alberto Matteelli
Antibiotics 2024, 13(5), 453; https://doi.org/10.3390/antibiotics13050453 - 16 May 2024
Cited by 1 | Viewed by 1738
Abstract
Cefiderocol is a new molecule effective against multidrug-resistant (MDR) Gram-negative pathogens. Currently, there is limited evidence regarding the use of cefiderocol in central nervous system (CNS) infections. Data on the cerebrospinal fluid penetration rate of cefiderocol are limited and heterogeneous, and there is [...] Read more.
Cefiderocol is a new molecule effective against multidrug-resistant (MDR) Gram-negative pathogens. Currently, there is limited evidence regarding the use of cefiderocol in central nervous system (CNS) infections. Data on the cerebrospinal fluid penetration rate of cefiderocol are limited and heterogeneous, and there is no consensus on the dosing scheme of cefiderocol to penetrate the blood–brain barrier. We present a case series and a literature review of CNS infections caused by MDR pathogens that were treated with cefiderocol: some of these patients were treated with different dose schemes of cefiderocol and underwent therapeutic drug monitoring both on plasma and cerebrospinal fluid (CSF). The CSF penetration rates and the clinical outcomes were evaluated. Full article
(This article belongs to the Special Issue Antimicrobial Treatment and Management of Central Nervous System Infections)
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11 pages, 1489 KiB  
Case Report
Cerebral Infectious Opportunistic Lesions in a Patient with Acute Myeloid Leukaemia: The Challenge of Diagnosis and Clinical Management
by Gabriele Cavazza, Cristina Motto, Caroline Regna-Gladin, Giovanna Travi, Elisa Di Gennaro, Francesco Peracchi, Bianca Monti, Nicolò Corti, Rosa Greco, Periana Minga, Marta Riva, Sara Rimoldi, Marta Vecchi, Carlotta Rogati, Davide Motta, Annamaria Pazzi, Chiara Vismara, Laura Bandiera, Fulvio Crippa, Valentina Mancini, Maria Sessa, Chiara Oltolini, Roberto Cairoli and Massimo Puotiadd Show full author list remove Hide full author list
Antibiotics 2024, 13(5), 387; https://doi.org/10.3390/antibiotics13050387 - 24 Apr 2024
Cited by 1 | Viewed by 1333
Abstract
Central nervous system (CNS) lesions, especially invasive fungal diseases (IFDs), in immunocompromised patients pose a great challenge in diagnosis and treatment. We report the case of a 48-year-old man with acute myeloid leukaemia and probable pulmonary aspergillosis, who developed hyposthenia of the left [...] Read more.
Central nervous system (CNS) lesions, especially invasive fungal diseases (IFDs), in immunocompromised patients pose a great challenge in diagnosis and treatment. We report the case of a 48-year-old man with acute myeloid leukaemia and probable pulmonary aspergillosis, who developed hyposthenia of the left upper limb, after achieving leukaemia remission and while on voriconazole. Magnetic resonance imaging (MRI) showed oedematous CNS lesions with a haemorrhagic component in the right hemisphere with lepto-meningitis. After 2 weeks of antibiotics and amphotericin-B, brain biopsy revealed chronic inflammation with abscess and necrosis, while cultures were negative. Clinical recovery was attained, he was discharged on isavuconazole and allogeneic transplant was postponed, introducing azacitidine as a maintenance therapy. After initial improvement, MRI worsened; brain biopsy was repeated, showing similar histology; and 16S metagenomics sequencing analysis was positive (Veilonella, Pseudomonas). Despite 1 month of meropenem, MRI did not improve. The computer tomography and PET scan excluded extra-cranial infectious–inflammatory sites, and auto-immune genesis (sarcoidosis, histiocytosis, CNS vasculitis) was deemed unlikely due to the histological findings and unilateral lesions. We hypothesised possible IFD with peri-lesion inflammation and methyl-prednisolone was successfully introduced. Steroid tapering is ongoing and isavuconazole discontinuation is planned with close follow-up. In conclusion, the management of CNS complications in immunocompromised patients needs an interdisciplinary approach. Full article
(This article belongs to the Special Issue Antimicrobial Treatment and Management of Central Nervous System Infections)
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7 pages, 220 KiB  
Case Report
Meropenem–Vaborbactam for the Treatment of Post-Neurosurgical Meningitis Caused by KPC Producer Klebsiella Pneumoniae: A Case Report and Review of the Literature
by Leonardo Francesco Rezzonico, Francesco Peracchi, Marta Vecchi, Gabriele Bassi, Marco Merli, Nicholas Brian Bana, Giovanna Travi, Fulvio Crippa and Massimo Puoti
Antibiotics 2024, 13(4), 331; https://doi.org/10.3390/antibiotics13040331 - 5 Apr 2024
Cited by 1 | Viewed by 1582
Abstract
Meningitis and ventriculitis, due to carbapenem-resistant Enterobacterales, are frequently associated with significant morbidity and mortality. In the case of multi-drug-resistant pathogens, it is necessary to consider the limited susceptibility profile as well as the penetration of the antimicrobials into the brain. Limited [...] Read more.
Meningitis and ventriculitis, due to carbapenem-resistant Enterobacterales, are frequently associated with significant morbidity and mortality. In the case of multi-drug-resistant pathogens, it is necessary to consider the limited susceptibility profile as well as the penetration of the antimicrobials into the brain. Limited data are available regarding the treatment of central nervous system infections caused by carbapenem-resistant Enterobacterales. We report a study of a patient treated with meropenem–vaborbactam in the case of post-neurosurgical meningitis due to carbapenemase-producing Klebsiella pneumoniae (CPKP). Full article
(This article belongs to the Special Issue Antimicrobial Treatment and Management of Central Nervous System Infections)
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