What is the recommended empiric coverage for patients at increased risk for S aureus and other pathogens due to recent neurosurgical procedures?

The recommended empiric coverage for patients at increased risk for Staphylococcus aureus and other pathogens following recent neurosurgical procedures is the combination of vancomycin and a third- or fourth-generation cephalosporin. This approach is selected because it addresses the potential for methicillin-resistant Staphylococcus aureus (MRSA) and provides broad-spectrum coverage against both Gram-positive and Gram-negative bacteria.

Vancomycin is crucial in this regimen due to its effectiveness against MRSA, which is a significant concern in the context of neurosurgery, where the risk of infection from resistant organisms is elevated. The inclusion of a third- or fourth-generation cephalosporin, such as ceftriaxone or cefepime, helps to cover a wide range of other possible pathogens, including gram-negative bacilli, which could be introduced during the surgical procedure.

This combination therapy not only targets the common organisms associated with post-neurosurgical infections but also addresses the risk of more resistant strains that may be encountered. The goal of this empiric strategy is to provide adequate coverage while awaiting culture results to tailor therapy more precisely based on antibiotic susceptibility.