Infected Cranioplasty
- Urgent Micro/ID Consult
- Urgent referral to neurosurgery. Source control with surgical management is essential.
- Consider drainage of pus, debridement and removal of cranioplasty
- Modify treatment according to sensitivity test results
- HIV testing is indicated
Treat empirically if no cultures have been performed before treatment started OR treatment can be guided by previous cultures (i.e. if an infecting organism has been isolated from aspiration of collection).
Duration of treatment:
- Superficial infection: 7-10 days
- Deep and/or complex infections: may require 4-6 weeks of treatment including oral follow on. For oral option see brain abscess.
Preferred empiric treatment
Includes penicillin allergy (non-severe) and patients with MRSA:
ceftazidime 2g iv tds (If patient is over 80 years of age the usual daily maximum dose of ceftazidime is 3g; this can be increased to 6g daily on advice documented by ID Micro Consultant)
AND
linezolid 600mg po bd (iv if NBM). (See linezolid drug monograph for information about monitoring required)
If unable to have linezolid: substitute linezolid with vancomycin iv
Alternative empiric treatment
For penicillin allergy (severe)
Consult Micro/ID who may recommend:
linezolid 600mg po bd (iv if NBM). (See linezolid drug monograph for information about monitoring required)
If unable to have linezolid: substitute linezolid with vancomycin iv
PLUS EITHER
Aztreonam 2g iv qds (in patients with a history of penicillin or cephalosporin allergy, aztreonam may be administered without prior testing unless there is a history of ceftazidime allergy)
OR
Ciprofloxacin* 500mg po bd (400mg iv bd if NBM)
Ciprofloxacin may induce seizures in patients with or without a history of seizures – use with caution
*Ensure that the patient is given the Fluoroquinolone MHRA patient information leaflet. Fluoroquinolones, including ciprofloxacin are associated with disabling and potentially long-lasting or irreversible side effects. See Fluoroquinolone antibiotics - severe adverse effects.