{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T13:24:07Z","timestamp":1788269047130,"version":"build-2803163510"},"reference-count":31,"publisher":"American Society for Microbiology","issue":"9","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["D43 TW009345"],"award-info":[{"award-number":["D43 TW009345"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>Central nervous system (CNS) infections cause high morbidity and mortality, especially in low- and middle-income countries, where the burden is unevenly distributed. This study aims to develop a diagnostic stewardship workflow (DSW) to improve diagnostic efficiency and increase pathogen detection in resource-limited settings. We conducted a prospective cross-sectional study in adults with suspected meningitis in Lima, Peru. Cerebrospinal fluid specimens were processed in parallel by the hospital laboratory (standard of care [SoC]) and an independent reference laboratory executing the DSW, enabling within-patient head-to-head comparison. The DSW was compared with the SoC using McNemar\u2019s and Cochran\u2019s Q tests with Holm\u2013Bonferroni correction. Among 103 adults (median age: 39 years, 36.9% HIV-positive), CNS infection was confirmed in 44 (42.7%), and a non-infectious etiology was diagnosed in 20 (19.4%). The DSW achieved significantly higher pathogen detection rates (97.7%; 43\/44 confirmed cases). Incremental yield over SoC was etiology-specific: 0 pp for cryptococcosis, +36 pp for tuberculous meningitis, +67 pp for bacterial meningitis, and +100 pp for viral encephalitis. A deterministic cost simulation showed that applying the DSW with sequential stopping rules would reduce per-cohort diagnostic expenditure by approximately 61% compared with the all-tests-to-all strategy applied in this study. A DSW substantially increases pathogen detection compared to standard diagnostic procedures, with the largest incremental gains for viral and difficult-to-culture bacterial pathogens, while reducing unnecessary testing and diagnostic costs and providing practical guidance to clinicians to streamline the diagnostic process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>IMPORTANCE<\/jats:title>\n                    <jats:p>We developed a meningitis diagnostic stewardship workflow using clinical information and initial test results to guide decision-making and streamline pathogen detection. This approach increased diagnostic yield, has the potential to reduce unnecessary testing, and may support more efficient diagnostic care in resource-limited settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.04173-25","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T13:00:26Z","timestamp":1785848426000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["Enhancing meningitis diagnosis: a diagnostic stewardship workflow in a resource-limited setting"],"prefix":"10.1128","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0687-3112","authenticated-orcid":false,"given":"Alfredo","family":"Chiappe Gonzalez","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02mb17771","id-type":"ROR","asserted-by":"publisher"}],"name":"Instituto de Investigaciones en Ciencias Biom\u00e9dicas, Universidad Ricardo Palma","place":["Lima, Peru"]},{"id":[{"id":"https:\/\/ror.org\/02cbk9w51","id-type":"ROR","asserted-by":"publisher"}],"name":"Hospital Nacional Dos de Mayo","place":["Lima, Peru"]},{"id":[{"id":"https:\/\/ror.org\/00cvxb145","id-type":"ROR","asserted-by":"publisher"}],"name":"Northern Pacific Global Health Research Fellows Training Consortium, University of Washington","place":["Seattle, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4566-2027","authenticated-orcid":true,"given":"Juan Carlos","family":"G\u00f3mez de la Torre","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02mb17771","id-type":"ROR","asserted-by":"publisher"}],"name":"Instituto de Investigaciones en Ciencias Biom\u00e9dicas, Universidad Ricardo Palma","place":["Lima, Peru"]},{"id":[{"id":"https:\/\/ror.org\/010xy3m51","id-type":"ROR","asserted-by":"publisher"}],"name":"Facultad de Medicina, Universidad de Piura","place":["Lima, Peru"]},{"name":"ROE Laboratorio Cl\u00ednico","place":["Lima, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3874-1432","authenticated-orcid":true,"given":"Juan Jos\u00e9","family":"Montenegro-Idrogo","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02cbk9w51","id-type":"ROR","asserted-by":"publisher"}],"name":"Hospital Nacional Dos de Mayo","place":["Lima, Peru"]},{"id":[{"id":"https:\/\/ror.org\/04xr5we72","id-type":"ROR","asserted-by":"publisher"}],"name":"Facultad de Ciencias de la Salud, Universidad Cient\u00edfica del Sur","place":["Lima, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicanor","family":"Mori","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02dxe8s77","id-type":"ROR","asserted-by":"publisher"}],"name":"Hospital Nacional Daniel A. 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