SANTRAL SİNİR SİSTEMİ ENFEKSİYONLARINDA SENDROMİK MOLEKÜLER TANI PANELİNİN GERÇEK YAŞAM PERFORMANSI: TEK MERKEZ DENEYİMİ

Abstract

Sendromik paneller, son yıllarda etkenleri hızlı ve güvenilir tanımlama potansiyelleri ile klinik mikrobiyoloji laboratuvarlarında öne çıkmıştır. Bu çalışmada, 1 Ocak 2020 – 30 Haziran 2025 tarihleri arasında üçüncü basamak bir üniversite hastanesinde çalışılan moleküler sendromik beyin omurilik sıvısı (BOS) panellerinde saptanan etkenlerin dağılımı, hastaların klinik özellikleri ve örneklerin laboratuvara kabulü ile sonuçların uzman tarafından onaylanması arasındaki sürelerin değerlendirilmesi amaçlanmıştır. Çalışmaya, 18 yaş ve üzeri hastalara ait BOS örnekleri dahil edilmiştir. Çalışmada 2020–2023 yıllarında BD MAX™ sistemi, 2024–2025 yıllarında ise Anatolia Geneworks’e ait Bosphore serisi paneller kullanılmıştır. Klinik ve laboratuvar veriler hastane bilgi yönetim sistemi kayıtlarından elde edilerek SPSS v23.0 programı ile analiz edilmiştir. Çalışma süresince toplam 523 BOS örneğinde moleküler sendromik panel testi uygulanmış; 28 farklı hastada (%5.4) viral veya bakteriyel etken saptanmıştır. Hastaların yaş ortalaması 46.7 ± 19.3 yıl olup, olguların %49.5’i erkektir. BOS örneklerinin laboratuvara kabulü ile sonuçların uzman tarafından onaylanması arasındaki medyan süre 22.5 saat olarak bulunmuştur. En sık saptanan etken olan Streptococcus pneumoniae’yı (%32.1) Epstein–Barr virüsü (%21.4) ve Herpes simpleks virüsü tip 1 (%14.3) izlemiştir. Bakteriyel etken pozitifliği saptanan 13 hastanın altısında (%46.2) BOS kültürü ile uyum gözlenmiştir. Moleküler sendromik BOS paneli negatif sonuçlanan 495 hastanın 41’inde (%8.3) konvansiyonel kültür yöntemleri ile etken saptanmış, bu etkenlerin büyük bölümünü koagülaz negatif stafilokoklar oluşturmuştur. Ayrıca panel kapsamı dışında kalan klinik açıdan anlamlı bazı patojenler de kültür ile saptanmıştır. Sonuç olarak, sendromik BOS panelleri hızlı etken saptama potansiyeline sahip olmakla birlikte konvansiyonel kültür yöntemlerinin yerini tamamen alamamaktadır. Bununla birlikte, her iki yöntemin birlikte kullanımı tanısal süreci destekleyerek klinik yönetimde katkı sağlayabilir. Elde edilen veriler, erişkin hastalarda sendromik BOS panellerinin gerçek yaşam koşullarındaki kullanımına ilişkin katkılarını ve sınırlılıklarını ortaya koymaktadır.

Keywords

• menenjit
• PCR
• sendromik tanı
• santral sinir sistemi

The Real World Performance of a Syndromic Molecular Diagnostic Panel in Central Nervous System Infections: A Single Center Experience

Abstract

Syndromic panels have gained prominence in clinical microbiology laboratories in recent years due to their potential for rapid and reliable identification of pathogens. This study aimed to evaluate the distribution of pathogens detected by molecular syndromic cerebrospinal fluid (CSF) panels performed between January 1, 2020, and June 30, 2025, in a tertiary care university hospital, together with the clinical characteristics of the patients and the turnaround time between sample receipt and result approval by a specialist. CSF samples obtained from patients aged 18 years and older were included. The BD MAX™ system was used between 2020 and 2023, while Bosphore series panels from Anatolia Geneworks were used between 2024 and 2025. Clinical and laboratory data were retrieved from the hospital information management system and analyzed using SPSS version 23.0. During the study period, molecular syndromic panel testing was performed on a total of 523 CSF samples, and viral or bacterial pathogens were detected in 28 patients (5.4%). The mean age of the patients was 46.7 ± 19.3 years, and 49.5% were male. The median turnaround time between sample receipt in the laboratory and result approval by a specialist was 22.5 hours. The most frequently detected pathogen was Streptococcus pneumoniae (32.1%), followed by Epstein–Barr virus (21.4%) and herpes simplex virus type 1 (14.3%). Among the 13 patients with bacterial positivity, concordance with CSF culture was observed in six cases (46.2%). Among the 495 patients with negative molecular syndromic CSF panel results, pathogens were detected by conventional culture methods in 41 cases (8.3%), with coagulase-negative staphylococci constituting the majority of isolates. In addition, several clinically significant pathogens not included in the panel spectrum were also identified by culture. In conclusion, although syndromic CSF panels offer the potential for rapid pathogen detection, they cannot fully replace conventional culture methods. However, the combined use of both approaches may support the diagnostic process and contribute to clinical management. The findings of this study highlight the contributions and limitations of syndromic CSF panels under real-world conditions in adult patients.

Keywords

• meningitis
• central nervous system
• PCR
• syndromic diagnosis

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