3
Typical Cerebrospinal Fluid Findings
Cell Count, Glucose and Protein
➤ Abnormalities of CSF cell count, glucose and/or protein may not
be reliable indicators for the presence of infection in patients with
healthcare-associated ventriculitis and meningitis (W-M).
➤ Normal CSF cell count, glucose and protein may not reliably exclude
infection in patients with healthcare-associated ventriculitis and
meningitis (W-M).
➤ A negative CSF Gram stain does not exclude the presence of infection,
especially in patients who have received previous antimicrobial
therapy (S-M).
Culture
➤ CSF cultures are the most important test to establish the diagnosis of
healthcare-associated ventriculitis and meningitis (S-H).
➤ If initial CSF cultures are negative in patients with CSF shunts or
drains with suspected infection, it is recommended that cultures
should be held for at least 10 days in an attempt to identify organisms
such as Propionibacterium acnes (S-H).
➤ If a CSF shunt or drain is removed in patients suspected of having
infection, cultures of shunt and drain components are recommended
(S-M).
➤ If a CSF shunt or drain is removed for indications other than infection,
cultures of shunt or drain components are NOT recommended (S-M).
➤ Blood cultures are recommended in patients with suspected
ventriculoatrial shunt infections (S-H).
➤ Blood cultures may be considered in patients with
ventriculoperitoneal and ventriculopleural shunts (W-L).
➤ Single or multiple positive CSF cultures in patients with CSF
pleocytosis and/or hypoglycorrhachia, or an increasing cell count,
and clinical symptoms suspicious for ventriculitis or meningitis, is
indicative of CSF drain infection (S-H).
➤ CSF and blood cultures in selected patients should be obtained
before the administration of antimicrobial therapy. A negative CSF
culture in the setting of previous antimicrobial therapy does not
exclude healthcare-associated ventriculitis and meningitis (S-M).
S, strong ; W, weak — strength of recommendation
H, high; M, moderate; L, low; VL, very low — quality of evidence
