Abstract
BackgroundThe epidemiology of CNS infections in Europe is dynamic, requiring that clinicians have access to up-to-date clinical management guidelines (CMGs) to aid identification of emerging infections and for improving quality and a degree of standardisation in diagnostic and clinical management practices. This paper presents a systematic review of CMGs for community-acquired CNS infections in Europe.MethodsA systematic review. Databases were searched from October 2004 to January 2019, supplemented by an electronic survey distributed to 115 clinicians in 33 European countries through the CLIN-Net clinical network of the COMBACTE-Net Innovative Medicines Initiative. Two reviewers screened records for inclusion, extracted data and assessed the quality using the AGREE II tool.ResultsTwenty-six CMGs were identified, 14 addressing bacterial, ten viral and two both bacterial and viral CNS infections. Ten CMGs were rated high quality, 12 medium and four low. Variations were identified in the definition of clinical case definitions, risk groups, recommendations for differential diagnostics and antimicrobial therapy, particularly for paediatric and elderly populations.ConclusionWe identified variations in the quality and recommendations of CMGs for community-acquired CNS infections in use across Europe. A harmonised European “framework-CMG” with adaptation to local epidemiology and risks may improve access to up-to-date CMGs and the early identification and management of (re-)emerging CNS infections with epidemic potential.
Highlights
Endemic, epidemic and emerging infectious diseases, including antimicrobial resistant organisms, remain a serious, cross-border threat to health in Europe
The survey asked clinicians which Clinical management guideline (CMG) they used in their daily practice to identify and manage patients presenting with syndromes of acute, community-acquired Central nervous system (CNS) infections, and asked them to submit the CMGs via hyperlink or by e-mail
Clinical management guidelines A total of 26 CMGs covering community-acquired suspected bacterial or viral CNS infections met the inclusion criteria for the review (Fig. 1)
Summary
Epidemic and emerging infectious diseases, including antimicrobial resistant organisms, remain a serious, cross-border threat to health in Europe. The epidemiology of encephalitis is constantly evolving [11], and emerging infectious diseases may present as undifferentiated CNS infections [12] This is ilustrated by the re-emergence of West Nile virus (WNV) in south-eastern Europe and the emergence of Toscana virus as a leading cause of aseptic meningitis in regions in southern Europe during the summer [13, 14]. Another cause of concern are recent outbreaks of enterovirus-associated severe neurological disease which cause a strain on paediatric intensive care units [15]. This paper presents a systematic review of CMGs for community-acquired CNS infections in Europe
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