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Retrospective analysis of multiplex polymerase chain reaction-based molecular diagnostics (SES) in 70 patients with
Rama Krishnan Tiruppur Chinnappan Ramalingam1, Dipanjan Chakraborty2
1Department of Neurology, Post Graduate Institute and KG Hospital, Coimbatore, Tamil Nadu, India.
Background:
Central nervous system (CNS) infections present a grave health care challenge due to high morbidity and mortality. Clinical findings and conventional laboratory assessments are not sufficiently distinct for specific etiologic diagnosis. Identification of pathogens is a key to appropriate therapy.
Aim:
In this retrospective observational study, we evaluated the efficacy and clinical utility of syndrome evaluation system (SES) for diagnosing clinically suspected CNS infections.
Materials And Methods:
This retrospective analysis included inpatients in our tertiary level neurointensive care unit (NICU) and ward from February 2010 to December 2013. Cerebrospinal fluid (CSF) samples of 70 patients, clinically suspected of having CNS infections, were subjected to routine laboratory tests, culture, imaging, and SES. We analyzed the efficacy of SES in the diagnosis of CNS infections and its utility in therapeutic decision-making.
Results:
SES had a clinical sensitivity of 57.4% and clinical specificity of 95.6%. Streptococcus pneumoniae and Pseudomonas aeruginosa were the top two bacterial pathogens, whereas Herpes simplex virus (HSV) was the most common viral pathogen. Polymicrobial infections were detected in 32.14% of SES-positive cases. SES elicited a change in the management in 30% of the patients from initial empiric therapy. At discharge, 51 patients recovered fully while 11 patients had partial recovery. Three-month follow-up showed only six patients to have neurological deficits.
Conclusion:
In a tertiary care center, etiological microbial diagnosis is central to appropriate therapy and outcomes. Sensitive and accurate multiplex molecular diagnostics play a critical role in not only identifying the causative pathogen but also in helping clinicians to institute appropriate therapy, reduce overuse of antimicrobials, and ensure superior clinical outcomes.
Insights
Syndrome Evaluation System (SES) aids in diagnosing central nervous system (CNS) infections, improving patient management and outcomes. This diagnostic tool helps identify pathogens and guides appropriate therapy, reducing antimicrobial overuse.
Area of Science:
- Neuroscience
- Infectious Diseases
- Clinical Diagnostics
Background:
- Central nervous system (CNS) infections pose significant morbidity and mortality risks.
- Current diagnostic methods lack specificity for precise etiological identification.
- Accurate pathogen identification is crucial for effective treatment.
Purpose of the Study:
- To evaluate the efficacy and clinical utility of the Syndrome Evaluation System (SES) for diagnosing CNS infections.
- To assess SES's impact on therapeutic decision-making in suspected CNS infections.
Main Methods:
- Retrospective observational study of 70 inpatients with suspected CNS infections.
- Analysis of cerebrospinal fluid (CSF) samples using routine tests, culture, imaging, and SES.
- Evaluation of SES performance in diagnosis and guiding treatment.
Main Results:
- SES demonstrated 57.4% sensitivity and 95.6% specificity.
- Common pathogens included *Streptococcus pneumoniae*, *Pseudomonas aeruginosa*, and Herpes simplex virus (HSV).
- SES altered management in 30% of patients, leading to improved recovery rates.
Conclusions:
- Etiological microbial diagnosis is paramount for optimal CNS infection therapy and outcomes.
- Multiplex molecular diagnostics, like SES, are vital for pathogen identification and guiding therapy.
- Accurate diagnostics reduce antimicrobial overuse and enhance clinical outcomes.
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