Clinical Impact of Cerebrospinal Fluid Multiplex Polymerase Chain Reaction (PCR) Testing in Children with Suspected Central Nervous System Infection

Abstract

Objective: Central nervous system (CNS) infections remain a significant cause of morbidity and mortality in children. This study aimed to evaluate the impact of cerebrospinal fluid (CSF), multiplex polymerase chain reaction (PCR) panel results on clinical decision-making and patient management in children who underwent lumbar puncture (LP) with a preliminary diagnosis of meningitis/meningoencephalitis. Methods: Patients aged 1 month to 18 years who underwent LP for suspected CNS infection in our pediatric emergency or intensive care units between 2018 and 2023, and who had a CSF multiplex PCR meningitis/encephalitis panel performed, were retrospectively evaluated in terms of demographics, clinical presentation, laboratory parameters, and treatments. Patients younger than 1 month or older than 18 years, those who underwent LP for non-infectious indications, and those with ventriculoperitoneal shunts were excluded. Data were analyzed using SPSS version 24. Results: The median age of the 144 patients was 2.7 (6.7) years, and 93 (64. 6%) were male. At least one pathogen was detected by multiplex PCR in 35 patients (24.3%). Of these, 22 had viral agents (enterovirus in 9, HSV-1 in 4, HHV-8 in 2, HHV-7 in 2, VZV in 2, CMV in 2, and HHV-6 in 1), 11 had bacterial agents [Streptococcus pneumoniae (S. pneumoniae) in 7, Neisseria meningitidis in 3, and Haemophilus influenzae type b (Hib) in 1], and 2 had multiple agents (S. pneumoniae + Hib + HHV-6 in one case; enterovirus + HHV-6 in one case). No significant clinical differences were observed between viral and bacterial infections. In 51 patients (35. 4%), treatment was modified based on PCR results, most often by discontinuing acyclovir (22. 1%), antibiotics (7. 6%), or both (3.5%). Conclusions: In approximately one-third of cases, unnecessary antiviral or antibiotic treatments were discontinued based on PCR results, demonstrating the utility of molecular diagnostics in guiding clinical management. Especially in patients who had received antibiotics prior to LP, early pathogen detection via PCR may help reduce treatment costs, complications, and length of hospital stay.