Clinical Characteristics and the Role of Biomarkers in the Differential Diagnosis of Community-Acquired Central Nervous System Infections: A Five-Year Retrospective Study Toplum Kökenli Santral Sinir Sistemi Enfeksiyonlarının Ayırıcı Tanısında Klinik Özellikler ve Biyobelirteçlerin Rolü: Beş Yıllık Retrospektif Çalışma
Mediterranean Journal of Infection, Microbes and Antimicrobials, cilt.15, sa.1, 2026 (ESCI, Scopus, TRDizin)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 15 Sayı: 1
- Basım Tarihi: 2026
- Doi Numarası: 10.4274/mjima.galenos.2026.26709
- Dergi Adı: Mediterranean Journal of Infection, Microbes and Antimicrobials
- Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, TR DİZİN (ULAKBİM)
- Anahtar Kelimeler: Central nervous system infections, meningitis, bacterial, cerebrospinal fluid, biomarkers, C -reactive protein
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Introduction: Community-acquired central nervous system infections (CA-CNSIs) are associated with substantial morbidity and mortality, and early differentiation between purulent and aseptic meningitis remains a major clinical challenge. Readily available admission biomarkers may facilitate timely clinical differentiation. Materials and Methods: We conducted a retrospective cohort study including adult patients (≥18 years) hospitalized with CA-CNSIs at Şişli Hamidiye Etfal Training and Research Hospital over a 5-year period. Epidemiological, clinical, and laboratory characteristics were evaluated. The diagnostic performance of routinely available biomarkers was assessed using receiver operating characteristic analysis. Multivariable Firth penalized logistic regression was applied, with internal validation performed using bootstrap resampling. Results: Seventy patients were included (median age, 45 years; 63% male). Purulent meningitis accounted for 46% of cases, whereas aseptic meningoencephalitis comprised 24%. Patients with purulent meningitis had significantly higher leukocyte counts and C-reactive protein (CRP) and procalcitonin levels, as well as a lower cerebrospinal fluid (CSF)-to-serum glucose ratio. The CSF-to-serum glucose ratio demonstrated the highest discriminative ability for differentiating purulent from aseptic meningitis [area under the curve (AUC), 0.97], followed by CRP (AUC, 0.89). In the multivariable analysis, the CSF-to-serum glucose ratio remained independently associated with purulent meningitis, with CRP providing additional discriminatory value. Conclusion: In this real-world cohort, the CSF-to-serum glucose ratio was the most robust admission biomarker for differentiating purulent from aseptic meningitis. CRP provided additional discriminatory value, supporting the combined use of routinely available biomarkers to improve early clinical decision-making in patients with suspected CA-CNSIs.