Professional Documents
Culture Documents
nervous system
Gary D. Overturf, MD
Objective: To define central nervous system infections of in- association of a compatible clinical syndrome or cerebrospinal
fants and children that occur as co-morbid or predisposing con- fluid changes associated with bacterial meningitis or other cen-
ditions of sepsis. tral nervous system infection, and confirmed as an anatomically
Design: Standard pediatric infectious disease references and defined infection by imaging or surgery, in association with
the pertinent literature in English were reviewed from 1960 to positive blood cultures or bacterial antigen from cerebrospinal
2002 to ascertain the previous methods and definitions utilized in fluid. Possible bacterial meningitis may be defined as a compat-
clinical studies of the epidemiology and treatment of bacterial ible clinical syndrome with predefined cerebrospinal fluid
infections of the central nervous system. An accepted definition of changes in the absence of a confirmatory culture or antigen test
bacterial meningitis defined by the Infectious Disease Society of from any site.
America was reviewed and adapted to the previous clinical def- Conclusions: Bacterial meningitis and other central nervous
initions. The information was formulated into a proposed standard system bacterial infections can be defined as definite, probable,
for definite, probable, and possible bacterial infections of the and possible with a combination of a defining compatible clinical
central nervous system. syndrome and an anatomic definition by surgery or imaging,
Results: The diagnosis of definite bacterial infection of the coupled with isolation of the organism, bacterial antigen, or other
central nervous system, including bacterial meningitis, requires defining molecular component of the organism. (Pediatr Crit Care
the isolation of the pathogen from the cerebrospinal fluid or other Med 2005; 6[Suppl.]:S14 –S18)
significant clinical site such as surgical tissue, an implanted KEY WORDS: central nervous system; cerebrospinal fluid; bacte-
device, or blood. Probable bacterial infection is defined by the rial meningitis; infection
T he pyogenic central nervous shunt infections, intracranial abscesses, America (IDSA) was adopted and com-
system infections of children and spinal infections, these infections are pared with those of the treatment studies
include bacterial meningitis, only infrequently accompanied by posi- and the standard definitions used by the
focal abscesses including in- tive blood cultures at the time of diagno- Centers for Disease Control, Active Bac-
tracranial, extracerebral, and intracere- sis, with the exception of certain patho- terial Core, and National Nosocomial In-
bral abscess, ventricular shunt infections gens (e.g., Staphylococcus aureus). fection Surveillance programs.
or ventriculitis, focal extracranial infec- Viral infection and its diagnosis will be
tions of the central nervous system (e.g., discussed because it represents the infec-
spinal, epidural, subdural or paraspinal tion causing the most frequent diagnostic Definitions of Bacterial
abscesses), and postoperative or trau- confusion. Although it is associated with Meningitis Before 1992
matic wound injury. Of these central ner- cerebrospinal fluid (CSF) pleocytosis and
Before 1992, definitions of bacterial
vous system infections, only bacterial overlaps with some clinical and neuro-
meningitis were nonstandardized and de-
meningitis is regularly associated with logic symptoms, it is defined by the ab-
fined for use in clinical antibiotic trials of
sepsis or bacteremia at the time of diag- sence of a recovery of a bacterial organ-
the treatment of bacterial meningitis,
nosis, with rates of positive blood cul- ism or specific bacterial antigen.
which were conducted after the introduc-
tures ranging from ⬍5% to ⬎25%. De-
tion of effective antibiotics in 1950. The
spite cryptic bacteremia as a cause of
Methods of Review definitions of bacterial meningitis in
these studies are represented by studies
Standard pediatric textbook references conducted between 1977 and 1990 (1– 8).
From the Departments of Pediatrics and Pathology,
University of New Mexico School of Medicine, Albu- and studies of the treatment and epide- Bacterial meningitis often was defined as
querque, NM. miology of bacterial meningitis from the a “compatible clinical syndrome” of men-
This work was supported by the Mannion Family English literature, published from 1960 ingitis plus a positive CSF culture, a pos-
Fund—Center for the Critically Ill Child, Division of to 2002, were examined. Representative itive bacterial antigen test, or positive
Critical Care Medicine at Children’s Hospital Boston,
the PALISI Network, and the ISF. studies that provided a complete defini- blood culture. However, because cultures
Copyright © 2005 by the Society of Critical Care tion used in the studies were included in of blood or CSF were negative in cases of
Medicine and the World Federation of Pediatric Inten- the final definitions. A standardized defi- presumed bacterial meningitis in approx-
sive and Critical Care Societies nition of bacterial meningitis formulated imately 10%–30% of cases, a concept of
DOI: 10.1097/01.PCC.0000161933.42822.86 by the Infectious Disease Society of “purulent unknown,” “pyogenic,” or “pre-