title: Retrospective analysis of multiplex polymerase chain reaction-based molecular diagnostics (SES) in 70 patients with suspected central nervous system infections: A single-center study.
abstract: 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.
  
  
  OBJECTIVE
  In this retrospective observational study, we evaluated the efficacy and clinical utility of syndrome evaluation system (SES) for diagnosing clinically suspected CNS infections.
  
  
  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 pneumoniaeandPseudomonas aeruginosawere 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurology, Post Graduate Institute and KG Hospital, Coimbatore, Tamil Nadu, India.
authors.forename: Rama Krishnan Tiruppur Chinnappan
authors.initials: RK
authors.lastname: Ramalingam
authors.affiliation: Clinical Research, XCyton Diagnostics Pvt. Ltd, Bangalore, Karnataka, India.
authors.forename: Dipanjan
authors.initials: D
authors.lastname: Chakraborty
keywords: Acute encephalitic syndrome (AES); meningitis; meningoencephalitis; molecular diagnostics; multiplex polymerase chain reaction; syndrome evaluation system (SES)