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Review
. 2018 Oct 25;56(11):e00861-18.
doi: 10.1128/JCM.00861-18. Print 2018 Nov.

Diagnostic Approach to Health Care- and Device-Associated Central Nervous System Infections

Ryan M Martin  1   2 , Lara L Zimmermann  1   2 , Mindy Huynh  3 , Christopher R Polage  4   5
Affiliations
Review

Diagnostic Approach to Health Care- and Device-Associated Central Nervous System Infections

Ryan M Martin et al. J Clin Microbiol. .

Abstract

Health care- and device-associated central nervous system (CNS) infections have a distinct epidemiology, pathophysiology, and microbiology that require a unique diagnostic approach. Most clinical signs, symptoms, and tests used to diagnose community-acquired CNS infections are insensitive and nonspecific in neurosurgical patients due to postsurgical changes, invasive devices, prior antimicrobial exposure, and underlying CNS disease. The lack of a standardized definition of infection or diagnostic pathway has added to this challenge. In this review, we summarize the epidemiology, microbiology, and clinical presentation of these infections, discuss the issues with existing microbiologic tests, and give an overview of the current diagnostic approach.

Keywords: central nervous system infections; implanted devices; meningitis; ventriculitis.

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Figures

FIG 1
FIG 1
CDC/NHSN criteria for the diagnosis of health care-associated meningitis or ventriculitis (53). *, elements in this line alone may not be used to meet the two required elements.
FIG 2
FIG 2
Proposed clinical algorithm for the evaluation of patients with clinically suspected health care- or device-associated central nervous system infection. CNS, central nervous system; CSF, cerebrospinal fluid; EVD, external ventricular device.
FIG 3
FIG 3
Proposed CSF testing algorithm and diagnostic classification. CSF, cerebrospinal fluid.
See this image and copyright information in PMC

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MeSH terms