Healthcare-Acquired Meningitis and Ventriculitis

Central nervous system infections associated with neurologic devices

“…The cumulative incidence of infection of CSF shunts ranges from 2.2 to 41% [1 ▪▪ ,2]. CSF shunt infections occur in approximately 3–15% of children and in approximately 5.6–12.9% in adults [10,11]. VP shunt infections can be superficial, involving only the skin or soft tissues surrounding the shunt valve, reservoir or tubing, or can be internal, involving the ventricles or the peritoneum [1 ▪▪ ].…”

“…As mentioned above, the clinical presentation of neurosurgical device infections varies based on virulence of the pathogen ( S. aureus or gram-negatives present acutely compared to more indolent pathogens such as coagulase-negative staphylococcus) and site of infection (surgical wound infection, meningitis, peritonitis, etc.) [1 ▪▪ ,10]. When meningitis is present, pleocytosis or a positive gram stain may suggest the diagnosis, however prior initiation of empiric antimicrobial therapy may affect these findings [23 ▪ ,24 ▪ ].…”

“…CSF shunt infections may present with fever, headache, nausea or vomiting, altered level of consciousness, pain and/or redness over the shunt tubing, localized signs of infection at the distal site of the shunt (e.g., peritonitis or pleuritis), or with shunt malfunction with no systemic signs of infections [1 ▪▪ ,10]. Other devices such as intrathecal infusion pumps and deep brain stimulators may present with a surgical wound infection with or without meningitis symptoms [2].…”

“…Biomarkers such as procalcitonin (PCT) and CSF lactate have been studied in suspected healthcare-associated meningitis and ventriculitis [1 ▪▪ ,2,10,23 ▪ ] but the interpretation of the result is hindered by lack of a standardized threshold value. One study of 15 patients showed a sensitivity and specificity of 68 and 77% for ventriculitis using a procalcitonin cutoff value of 1.0 ng/ml [29].…”

“…When the intracranial infection is suspected, brain imaging, ideally with contrasted MRI is recommended [1 ▪▪ ,2,10]. Cranial imaging can detect hydrocephalus, hemorrhage, suppurative intracranial infections or used to assess shunt malfunction [1 ▪▪ ,10].…”