What are the IDSA guidelines on the diagnosis of healthcare-associated ventriculitis and meningitis?

Updated: Jul 16, 2019
  • Author: Rodrigo Hasbun, MD, MPH; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

IDSA guidelines on the diagnosis of healthcare-associated ventriculitis and meningitis are as follows: [52]

  • New headache, fever, evidence of meningeal irritation, seizures, and/or worsening mental status suggest ventriculitis or meningitis in the setting of recent trauma or neurosurgery.
  • Fever, in the absence of another clear source of infection, suggests CNS infection in the setting of recent head trauma or neurosurgery.
  • New headache, nausea, lethargy, and/or change in mental status suggest CSF shunt infection.
  • Erythema and tenderness over the subcutaneous shunt tubing suggest CSF shunt infection.
  • Symptoms and signs of peritonitis or abdominal tenderness in patients with ventriculoperitoneal shunts, in the absence of another clear etiology, indicate CSF shunt infection.
  • Demonstration of bacteremia in a patient with a ventriculoatrial shunt, in the absence of another clear source of bacteremia, is evidence of CSF shunt infection.
  • Symptoms and signs of pleuritis in patients with ventriculopleural shunts, in the absence of another clear etiology, indicate CSF shunt infection.
  • Single or multiple positive CSF culture results in patients with CSF pleocytosis and/or hypoglycorrhachia, or an increasing cell count, and clinical symptoms suspicious for ventriculitis or meningitis, indicates CSF drain infection.
  • CSF cultures are the most important test to establish the diagnosis of healthcare-associated ventriculitis and meningitis.
  • If initial CSF culture results are negative in patients with CSF shunts or drains with suspected infection, cultures should be held for at least 10 days in an attempt to identify organisms such as P acnes.
  • Blood cultures are recommended in patients with suspected ventriculoatrial shunt infections.
  • CSF and blood cultures in selected patients should be obtained before the administration of antimicrobial therapy; a negative CSF culture result in the setting of previous antimicrobial therapy does not exclude healthcare-associated ventriculitis and meningitis.
  • CSF pleocytosis with a positive culture result and symptoms of infection indicate a diagnosis of healthcare-associated ventriculitis or meningitis.
  • CSF cultures that grow S aureus or aerobic gram-negative bacilli indicate infection.
  • CSF cultures that grow a fungal pathogen indicate infection.
  • Neuroimaging is recommended in patients with suspected healthcare-associated ventriculitis and meningitis.
  • MRI with gadolinium enhancement and diffusion-weighted imaging is recommended for detecting abnormalities in patients with healthcare-associated ventriculitis and meningitis.
  • In patients with infected ventriculoperitoneal shunts and abdominal symptoms (eg, pain or tenderness), ultrasonography or CT scanning of the abdomen is recommended to detect CSF loculations at the shunt terminus.

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