4
Diagnosis
Neurosurgery or Head Trauma
➤ CSF pleocytosis with a positive culture and symptoms of infection
are indicative of a diagnosis of healthcare-associated ventriculitis or
meningitis (S-H).
➤ Hypoglycorrhachia and elevated CSF protein concentrations are
suggestive of the diagnosis of healthcare-associated ventriculitis or
meningitis (W-L).
➤ Growth of an organism which is commonly considered a contaminant
(e.g., coagulase-negative Staphylococcus) in enrichment broth only
or on just one of multiple cultures, in a patient with normal CSF and
no fever, is not indicative of healthcare-associated ventriculitis or
meningitis (S-L).
➤ CSF cultures with multiple organisms from a single sample may
be contaminants in patients with no symptoms of infection or CSF
pleocytosis (W-L).
➤ CSF cultures that grow Staphylococcus aureus or aerobic gram-
negative bacilli are indicative of infection (S-M).
➤ CSF cultures that grow a fungal pathogen are indicative of infection
(S-M).
Specific CSF Tests to Confirm the Diagnosis
➤ An elevated CSF lactate or an elevated CSF procalcitonin, or the
combination of both, may be useful in the diagnosis of healthcare-
associated bacterial ventriculitis and meningitis (W-M).
➤ An elevated serum procalcitonin may be useful in differentiating
between CSF abnormalities due to surgery or intracranial hemorrhage
from those due to bacterial infection (W-L).
➤ Nucleic acid amplification tests, such as polymerase chain reaction
(PCR), on CSF may both increase the ability to identify a pathogen
and decrease the time to making a specific diagnosis (W-L).
➤ Detection of β–D-glucan and galactomannan in CSF may be useful in
the diagnosis of fungal ventriculitis and meningitis (S-M).
