Central nervous system infections rarely underlie presumed delirium in ICU admissions: insights from the Swiss ICU registry

Delirium, a neuropsychiatric syndrome with high morbidity and mortality, affects up to 80% of mechanically ventilated intensive care unit (ICU) patients [1] with a recently decreasing 50% incidence due to improved care [2]. Given that central nervous system (CNS) infections induce cerebral dysfunction, guidelines recommend cerebral spinal fluid (CSF) analysis in cases of unexplained neurological impairment, particularly with infectious/inflammatory signs [3]. Due to overlapping clinical features between delirium and CNS infections—and implications of diagnostic delay—lumbar puncture is performed in up to 50% of delirious patients [4], despite procedural risks. …