Epidemiological and Laboratory Evaluation of Central Nervous System Infections Using the BioFire FilmArray Meningitis/Encephalitis Panel in a Tertiary Care Hospital in İstanbul.

ObjectiveRapid and accurate identification of central nervous system (CNS) pathogens is essential for appropriate antimicrobial management. This study aimed to evaluate the performance of the BioFire FilmArray Meningitis/Encephalitis (ME) Panel compared with conventional cerebrospinal fluid (CSF) analysis.Materials and methodsThis retrospective study was conducted at a tertiary care hospital over a three-year period. Cerebrospinal fluid samples were analyzed using routine microbiological methods (culture and Gram staining), cytological examination, biochemical testing, and multiplex PCR with the BioFire FilmArray ME Panel.ResultsA total of 1470 CSF samples were analyzed, and pathogens were detected in 104 samples (7.1%), including 57 viral pathogens, 39 bacterial pathogens, one fungal pathogen, and six co-infections. Culture positivity was observed in one case each of Streptococcus pneumoniae and Cryptococcus neoformans, both concordant with PCR findings. Bacterial infections were associated with significantly lower CSF glucose levels (42.57 ± 26.07 mg/dL) and higher lactate dehydrogenase (LDH) levels (320.33 ± 455.76 IU/L) than viral infections (60.38 ± 18.88 mg/dL and 53.08 ± 26.85 IU/L, respectively). The proportion of polymorphonuclear leukocytes (PMNLs) was significantly higher in bacterial cases. Receiver operating characteristic (ROC) analysis demonstrated good discriminatory performance for LDH (area under the receiver operating characteristic curve [AUC] = 0.917) and PMNL percentage (AUC = 0.834). Viral pathogens were more frequent in the 0-2-year age group, whereas bacterial infections predominated in older children.ConclusionThe BioFire FilmArray ME Panel, when interpreted in conjunction with routine CSF biochemical and cytological parameters, provides a rapid and reliable diagnostic approach for differentiating bacterial from viral CNS infections.Graphical abstractGraphical Abstract.