Management of Multidrug-Resistant Central Nervous System Infections
Summary
Multidrug-resistant (MDR) infections of the central nervous system (CNS) represent a growing threat to global health, driven by the rise of carbapenem-resistant and extensively drug-resistant Gram-negative bacteria such as Acinetobacter baumannii and Klebsiella pneumoniae, as well as vancomycin-resistant Gram-positive pathogens. The blood–brain barrier (BBB) imposes a significant obstacle to achieving therapeutic drug concentrations in cerebrospinal fluid (CSF), limiting the efficacy of many standard antimicrobial agents. Contemporary management combines rapid pathogen identification, optimisation of systemic antimicrobial regimens guided by pharmacokinetic and pharmacodynamic principles, and adjunctive intrathecal or intraventricular therapy to overcome restricted drug penetration. Surgical measures, including drainage of abscesses and removal or irrigation of infected hardware, remain essential in cases of ventriculitis and device-related meningitis. Preventive strategies focus on antibiotic prophylaxis protocols in neurosurgical settings and strict infection-control practices. Multidisciplinary care involving infectious-disease specialists, neurosurgeons and critical-care teams is critical to improving outcomes and curbing the emergence of further resistance.
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Management of Multidrug-Resistant Central Nervous System Infections publication trend
The graph below shows the total number of articles in management of multidrug-resistant central nervous system infections across all publications each year (not limited to Nature Index journals).
Technical terms
Blood–brain barrier (BBB): A selective endothelial interface that restricts passage of many drugs from the bloodstream into the CNS.
Cerebrospinal fluid (CSF): Fluid surrounding the brain and spinal cord, used for diagnostic sampling and therapeutic delivery in CNS infections.
Intraventricular therapy (IVT): Direct administration of antimicrobial agents into the cerebral ventricles to bypass the BBB.
Multidrug-resistant (MDR) bacteria: Pathogens resistant to at least three classes of antimicrobial agents, complicating treatment options.
Pharmacokinetics: The study of drug absorption, distribution, metabolism and excretion, crucial for optimising dosing in CNS infections.
References
- Clinical outcomes and risk factors of Acinetobacter baumannii meningitis in pediatric patients at a tertiary hospital in China. Frontiers in Cellular and Infection Microbiology (2024).
- New Antibiotics for the Treatment of Nosocomial Central Nervous System Infections. Antibiotics (2024).
- Effect of antibiotic prophylaxis in the prognosis of Post-neurosurgical meningitis patients. European Journal of Medical Research (2023).
- Efficacy of intravenous plus intrathecal/intracerebral ventricle injection of polymyxin B for post-neurosurgical intracranial infections due to MDR/XDR Acinectobacter baumannii: a retrospective cohort study. Antimicrobial Resistance & Infection Control (2018).
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