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Why is syndromic testing beneficial for meningitis?

If not immediately treated, meningitis can become very serious, resulting in permanent brain or nerve damage
Example Of Rapid Syndromic Testing Meningitis Case
© BSAC

Meningitis is an infection (viral or, more rarely, bacterial) resulting in the inflammation of membranes (the meninges) lining the spinal cord and brain. It most commonly affects babies, children, and young adults.

If not immediately treated, meningitis can become very serious, resulting in permanent brain or nerve damage. Even with immediate treatment, however, patients can be left with serious lifelong complications such as partial or complete sight/hearing loss, epilepsy, and loss of limbs (sometimes necessitating the amputation of affected limbs).

Syndromic testing benefits meningitis diagnosis and treatment.

Symptoms, diagnosis and treatment of meningitis; pyrexia (≥ 38°C), headache, light sensitivity (photophobia), vomiting, neck stiffness, seizures, rash (usually seen for meningococcal septicaemia); diagnosed initially by clinical examination and confirmed by a lumbar puncture for cerebrospinal fluid analysis and culture/PCR; treated with IV antibiotics if bacterial and acyclovir if viral

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Meningitis case

A hospital study investigating the use of on-site multiplex polymerase chain reaction (PCR) diagnostics for cerebrospinal fluid (CSF) samples in cases of suspected central nervous system (CNS) infection, found rapid syndromic testing to be both cost-effective and helpful in clarifying areas of diagnostic uncertainty. It was conducted from April 2019 to April 2020 for 14 common pathogens.

The study assessed differences in antibiotic prescribing, length of stay (LOS) and hospital expenditure, and consisted of two ‘cohorts’:

  1. ‘Cohort 1’: the pre-PCR diagnostics group, tested prior to the introduction of the rapid diagnostics for use in CNS infections (n=50, 17 children, 33 adults)
  2. ‘Cohort 2’: the post-PCR diagnostics group, with CSF samples tested using rapid syndromic testing (n=72, 26 children, 46 adults)

Like other similar studies, this study found that there was particularly vital diagnostic value for the paediatric population – who often display less discriminatory symptoms – increasing diagnosis in children with bacterial meningitis.

Other findings included:

The study found that there was decreased antimicrobial consumption in Enterovirus-positive results, for Cohort 2 compared to Cohort 1; €1,402 saved per case; no statistically significant difference in total LOS, but decreased LOS when analysed for Enterovirus-positive cases (for Cohort 2 compared to Cohort 1)

The above image is available as a PDF
© BSAC
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Syndromic Testing and Antimicrobial Stewardship

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