PMID- 36971564 OWN - NLM STAT- Publisher LR - 20230415 IS - 2165-0497 (Electronic) IS - 2165-0497 (Linking) VI - 11 IP - 2 DP - 2023 Mar 27 TI - Rational Use of Microbiological Tests in the Diagnosis of Central Nervous System Infections Using Restrictive Criteria: a Retrospective Study. PG - e0317922 LID - 10.1128/spectrum.03179-22 [doi] LID - e03179-22 AB - Central nervous infections, mostly represented by meningitis and encephalitis, remain a diagnostic challenge despite substantial advances in microbiological tools in recent years. Meanwhile, extensive microbiological workups, which often prove to be irrelevant retrospectively, continue to be processed on a large scale, therefore leading to unnecessary costs. The main goal of this study was to evaluate a systematic approach enabling more rational use of microbiological tools in the setting of community-acquired central nervous system infection diagnosis. In this single-center descriptive study, the modified Reller criteria were retrospectively extended to all neuropathogens tested in cerebrospinal fluid (CSF) samples with the FilmArray meningitis/encephalitis panel (BioFire Diagnostics, LLC) and bacterial culture. The inclusion period was 30 months. In total, 1,714 fluid (CSF) samples analyzed from 1,665 patients over 2 and a half years were reported. According to the retrospective application of the modified Reller criteria, microbiological testing was considered unnecessary in 544 CSF samples. Fifteen positive microbiological results were found among these samples, interpreted either as inherited chromosomally integrated human herpesvirus 6 (HHV-6), a false-positive result, or a true microbial detection without clinical relevance. No CNS infection case would have been missed if these analyses were not carried out, while about one-third of all meningitis/encephalitis multiplex PCR panels would have been saved. Our retrospective analysis suggests that the modified Reller criteria could be safely applied to all microbiological tests performed in CSF, thereby saving substantial costs. IMPORTANCE Microbiological testing in general and in the setting of central nervous system (CNS) infection in particular are often excessive, leading to superfluous laboratory work and costs. In this regard, restrictive criteria, named Reller criteria, have been developed to reduce unnecessary CSF herpes simplex virus 1 (HSV-1) PCR testing when suspecting encephalitis. These criteria were then adapted for increased safety to become the modified Reller criteria. This retrospective study aims at evaluating the safety of these criteria when applied to CSF microbiological testing in general, including multiplex PCR, direct examination, and bacterial culture. The postulate was that a CNS infection can be excluded if none of these criteria is present. According to our data set, no CNS infection would have been missed if the modified Reller criteria would have been applied to save microbiological tests. This study therefore proposes a simple way to reduce unnecessary microbiological testing in the context of CNS infection suspicion. FAU - Ngo Nsoga, M T AU - Ngo Nsoga MT AUID- ORCID: 0000-0001-8299-5432 AD - Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland. AD - Faculty of Medicine, University of Geneva, Geneva, Switzerland. FAU - Perez-Rodriguez, F J AU - Perez-Rodriguez FJ AUID- ORCID: 0000-0003-0380-9625 AD - Laboratory of Virology, Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland. FAU - Mamin, A AU - Mamin A AD - Laboratory of Virology, Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland. FAU - L'Huillier, A G AU - L'Huillier AG AUID- ORCID: 0000-0001-9230-7285 AD - Faculty of Medicine, University of Geneva, Geneva, Switzerland. AD - Laboratory of Virology, Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland. AD - Pediatric Infectious Diseases Unit, Department of Women, Children and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland. FAU - Cherkaoui, A AU - Cherkaoui A AUID- ORCID: 0000-0002-1801-5935 AD - Faculty of Medicine, University of Geneva, Geneva, Switzerland. AD - Laboratory of Bacteriology, Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland. FAU - Kaiser, L AU - Kaiser L AD - Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland. AD - Faculty of Medicine, University of Geneva, Geneva, Switzerland. AD - Laboratory of Virology, Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland. FAU - Schibler, M AU - Schibler M AD - Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland. AD - Faculty of Medicine, University of Geneva, Geneva, Switzerland. AD - Laboratory of Virology, Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland. LA - eng PT - Journal Article DEP - 20230327 PL - United States TA - Microbiol Spectr JT - Microbiology spectrum JID - 101634614 SB - IM PMC - PMC10100671 OTO - NOTNLM OT - central nervous system infections OT - modified Reller criteria OT - unnecessary microbiological testing COIS- The authors declare no conflict of interest. EDAT- 2023/03/28 06:00 MHDA- 2023/03/28 06:00 PMCR- 2023/03/27 CRDT- 2023/03/27 10:11 PHST- 2023/03/27 10:11 [entrez] PHST- 2023/03/28 06:00 [pubmed] PHST- 2023/03/28 06:00 [medline] PHST- 2023/03/27 00:00 [pmc-release] AID - 03179-22 [pii] AID - spectrum.03179-22 [pii] AID - 10.1128/spectrum.03179-22 [doi] PST - aheadofprint SO - Microbiol Spectr. 2023 Mar 27;11(2):e0317922. doi: 10.1128/spectrum.03179-22.