Investigating the efficiency of the multiplex real-time polymerase chain reaction method in patients with prediagnosis of meningitis and encephalitis in the emergency department

ACAN B, Investigating the Efficiency of the Multiplex Real-Time Polymerase Chain Reaction Method in Patients with Prediagnosis of Meningitis and Encephalitis in the Emergency Department, Hacettepe University Faculty of Medicine, Thesis of Emergency Medicine, Ankara, 2023. Meningitis and encephalitis are critical diseases of central nervous system with high morbidity and mortality rates, which should be treated empirically in early period. Complications may also develop due to the empirical treatment until the administration of definitive treatment. In this study, it was aimed to investigate the effect of the Seegene® Allplex Meningitis Panel, which can determine the agent in a short period by using the multiplex real-time polymerase chain reaction (PCR) method, on duration of empirical treatment and hospitalization, complications, and costs by comparing its results with standard methods. Cerebro-spinal fluid samples which were collected from 50 patients who admitted between 1 July 2021 and 31 January 2022 and followed up in Hacettepe University, Adult Emergency Service, were evaluated for agent determination by standard methods and meningitis panel. The reliability of the meningitis panel was evaluated by kappa statistic on 45 patients after excluding 5 patients who were found to be positive for agents other than 18 microorganisms which can be detected by meningitis panel. Meningitis panel had a sensitivity of 83.3%, a specificity of 97.4%, and a negative predictive value of 97.4%. Furthermore, in 10 patients who were thought to develop Acute Kidney Injury secondary to empirical acyclovir treatment although the viral PCR results was negative, it was predicted that if the agent was determined by the meningitis panel earlier, empirical treatment wouldn't be necessary and the costs would be reduced by preventing possible complications (p=0.005). In conclusion; when compared with standard methods in terms of pathogens that Seegene® Allplex Meningitis Panel can detect, it is thought that this method will shorten the empirical treatment duration, reduce the complications, length of stay and costs by giving results compatible with standard methods in a very short time. Keywords: Emergency department, meningitis, encephalitis, multiplex PCR