CNS Infections Management

Diagnostic Approach

The American College of Critical Care Medicine recommends obtaining CSF from the EVD reservoir in patients with intracranial devices 1
The Infectious Diseases Society of America suggests that a CSF-to-blood glucose ratio above 0.23 may indicate bacterial infection, but this should be interpreted with caution and in the context of other clinical and laboratory findings 2
The European Society of Clinical Microbiology and Infectious Diseases states that Gram stain sensitivity is limited, and negative results do not exclude bacterial infection 3

The American College of Radiology recommends MRI with DWI/ADC and T1-weighting with and without gadolinium as the preferred method for diagnosing brain abscesses 4
The European Society of Clinical Microbiology and Infectious Diseases suggests that MRI is superior to CT for subtle examination of brain parenchyma and meninges 5

The Infectious Diseases Society of America recommends starting empirical antibiotics immediately after obtaining blood cultures if bacterial meningitis is suspected and LP is delayed 1, 2, 6
The European Society of Clinical Microbiology and Infectious Diseases suggests that empirical therapy should include a third-generation cephalosporin combined with metronidazole for community-acquired brain abscesses 4

The European Society of Clinical Microbiology and Infectious Diseases strongly recommends neurosurgical aspiration or excision as early as possible for brain abscesses 4
The American College of Critical Care Medicine suggests that shunt removal is often necessary for the treatment of CNS shunt infections 1

The Centers for Disease Control and Prevention recommends appropriate prophylaxis (narrow spectrum, just before incision, discontinued within 24 hours) to reduce infection risk at shunt placement 1