Central Nervous System Infection

The “Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals” protocol adopts the following definition of Central Nervous System Infection (CNS).

CNS-IC: intracranial infection (brain abscess, subdural or epidural infection, encephalitis).

Intracranial infection must meet at least one of the following criteria

• patient has organisms cultured from brain tissue or dura;
• patient has an abscess or evidence of intracranial infection seen during a surgical operation or histopathologic examination;
• patient has at least two of the following signs or symptoms with no other recognised cause: headache,
• dizziness, fever (> 38 °C), localising neurologic signs, changing level of consciousness, or confusion,

and at least one of the following:

• organisms seen on microscopic examination of brain or abscess tissue obtained by needle aspiration or by biopsy during a surgical operation or autopsy;
• positive antigen test on blood or urine;
• radiographic evidence of infection, e.g. abnormal findings on ultrasound, CT scan, MRI, radionuclide brain scan, or arteriogram;
• diagnostic single antibody titre (IgM) or fourfold increase in paired sera (IgG) for pathogen

and

• if the diagnosis is made antemortem, the physician institutes appropriate antimicrobial therapy.
• if meningitis and a brain abscess are present together, the infection must be reported as CNS-IC.

CNS-MEN: meningitis or ventriculitis.

Meningitis or ventriculitis must meet at least one of the following criteria

• patient has organisms cultured from cerebrospinal fluid (CSF);
• patient has at least one of the following signs or symptoms with no other recognised cause:
• fever (> 38 °C), headache, stiff neck, meningeal signs, cranial nerve signs, or irritability,

and at least one of the following:

• increased white cells, elevated protein, and/or decreased glucose in CSF;
• organisms seen on Gram’s stain of CSF;
• organisms cultured from blood;
• positive antigen test of CSF, blood, or urine;
• diagnostic single antibody titre (IgM) or fourfold increase in paired sera (IgG) for pathogen

and

• if the diagnosis is made antemortem, the physician institutes appropriate antimicrobial therapy.

Further instructions for reporting:

• CSF shunt infection must be reported as SSI-O if it occurs <=1 year of placement; if later or after manipulation/access of the shunt, report as CNS-MEN;
• meningoencephalitis must be reported as CNS-MEN;
• spinal abscess with meningitis must be reported as CNS-MEN.

CNS-SA: spinal abscess without meningitis.

An abscess of the spinal epidural or subdural space, without the involvement of the cerebrospinal fluid or adjacent bone structures, must meet at least one of the following criteria

• patient has organisms cultured from an abscess in the spinal epidural or subdural space;
• patient has an abscess in the spinal epidural or subdural space seen during a surgical operation or at autopsy or evidence of an abscess seen during a histopathologic examination;
• patient has at least one of the following signs or symptoms with no other recognised cause: fever (> 38 °C), back pain, focal tenderness, radiculitis, paraparesis, or paraplegia,

and at least one of the following:

• organisms cultured from blood;
• radiographic evidence of a spinal abscess, e.g. abnormal findings on myelography, ultrasound, CT scan, MRI, or other scans (gallium, technetium, etc.);

and

• if the diagnosis is made antemortem, the physician institutes appropriate antimicrobial therapy.
• Spinal abscess with meningitis must be reported as meningitis.

Link to European IC/HH Core Competencies

• Area 3. Surveillance and investigation of healthcare-associated infection (HAI)

References

• http://www.ecdc.europa.eu/en/publications/Publications/0512-TED-PPS-HAI-antimicrobial-use-protocol.pdf