{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:49:23Z","timestamp":1782175763397,"version":"3.54.5"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"vor","delay-in-days":50,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009232","name":"University of Debrecen","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009232","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Spontaneous Gram-negative bacillary meningitis in adults is rare and carries high mortality, particularly in elderly patients with significant comorbidities. Although multiplex meningitis-encephalitis (ME) panels have improved diagnostic turnaround time, their limited pathogen spectrum may reduce sensitivity for certain clinically relevant Gram-negative organisms. We report a 78-year-old man presenting with acute meningoencephalitis, septic deterioration, and cerebrospinal fluid (CSF) findings strongly suggestive of bacterial infection. Despite marked neutrophilic pleocytosis and elevated protein levels, the multiplex ME panel was negative. Blood cultures subsequently yielded\n                    <jats:italic>Proteus mirabilis<\/jats:italic>\n                    . Given the discordance between inflammatory CSF findings and routine molecular testing, following interdisciplinary consultation, an off-label BioFire\n                    <jats:sup>\u00ae<\/jats:sup>\n                    Joint Infection multiplex PCR panel was performed directly on CSF. The assay identified\n                    <jats:italic>Proteus mirabilis<\/jats:italic>\n                    harboring a cefotaximase-Munich (CTX-M)-type extended-spectrum \u03b2-lactamase (ESBL) resistance determinant. Based on this result, antimicrobial therapy was escalated from ceftriaxone-based empiric treatment to meropenem prior to availability of phenotypic susceptibility data. Despite early pathogen identification and targeted antimicrobial therapy, the patient died due to multiorgan dysfunction secondary to severe sepsis. This case suggests a potential diagnostic limitation of standard ME panels in selected high-risk scenarios and indicates that selective off-label use of broader multiplex PCR platforms may provide additional clinically relevant information in carefully selected patients. In the setting of high clinical suspicion and negative routine multiplex testing, rapid resistance-gene detection may provide actionable information within a decisive therapeutic window and support timely antimicrobial optimization in severe Gram-negative central nervous system infections. Further studies are required to evaluate the diagnostic performance and clinical impact of such approaches. Written informed consent for publication was obtained from the patient\u2019s next of kin, and the study was conducted in accordance with institutional and ethical standards.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Clinical trial number<\/jats:bold>\n                    Not applicable.\n                  <\/jats:p>","DOI":"10.1186\/s12879-026-13485-2","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T09:16:52Z","timestamp":1777886212000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["When the meningitis\u2013encephalitis panel is negative: off-label joint infection PCR detects CTX-M ESBL\u2013producing Proteus mirabilis in adult meningoencephalitis"],"prefix":"10.1186","volume":"26","author":[{"given":"M\u00e1rk","family":"Koz\u00e1k","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Levente","family":"Majoros","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferenc","family":"Bodn\u00e1r","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebeka","family":"Hodossy-Tak\u00e1cs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilla","family":"Hud\u00e1k","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilla","family":"R\u00e1cz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktor","family":"Bencs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Istv\u00e1n","family":"V\u00e1rkonyi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"13485_CR1","doi-asserted-by":"publisher","unstructured":"GBD 2016 Meningitis Collaborators. Global, regional, and national burden of meningitis, 1990\u20132016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018;17:1061\u20131082. https:\/\/doi.org\/10.1016\/S1474-4422(18)30387-9.","DOI":"10.1016\/S1474-4422(18)30387-9"},{"key":"13485_CR2","doi-asserted-by":"publisher","first-page":"1849","DOI":"10.1056\/NEJMoa040845","volume":"351","author":"D Van De Beek","year":"2004","unstructured":"Van De Beek D, De Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical Features and Prognostic Factors in Adults with Bacterial Meningitis. N Engl J Med. 2004;351:1849\u201359. https:\/\/doi.org\/10.1056\/NEJMoa040845.","journal-title":"N Engl J Med"},{"key":"13485_CR3","doi-asserted-by":"publisher","first-page":"2147","DOI":"10.1001\/jama.2022.20521","volume":"328","author":"R Hasbun","year":"2022","unstructured":"Hasbun R. Progress and Challenges in Bacterial Meningitis: A Review. JAMA. 2022;328:2147. https:\/\/doi.org\/10.1001\/jama.2022.20521.","journal-title":"JAMA"},{"key":"13485_CR4","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1016\/S1473-3099(14)70805-9","volume":"14","author":"RL Castelblanco","year":"2014","unstructured":"Castelblanco RL, Lee M, Hasbun R. Epidemiology of Bacterial Meningitis in the USA from 1997 to 2010: A Population-Based Observational Study. Lancet Infect Dis. 2014;14:813\u20139. https:\/\/doi.org\/10.1016\/S1473-3099(14)70805-9.","journal-title":"Lancet Infect Dis"},{"key":"13485_CR5","doi-asserted-by":"publisher","first-page":"101120","DOI":"10.1016\/j.lana.2025.101120","volume":"47","author":"N Prasad","year":"2025","unstructured":"Prasad N, Kobayashi M, Collins JP, Rubis AB, Derado G, Delahoy MJ, Payne DC, McGee L, Chochua S, Marjuki H, et al. The Epidemiology of Bacterial Meningitis in the United States during 2008\u20132023: An Analysis of Active, Laboratory, Population-Based, Multistate Surveillance Data. Lancet Reg Health Am. 2025;47:101120. https:\/\/doi.org\/10.1016\/j.lana.2025.101120.","journal-title":"Lancet Reg Health Am"},{"key":"13485_CR6","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.39225","author":"FF Costa Filho","year":"2023","unstructured":"Costa Filho FF, Furlan A, Avner BS. Spontaneous Proteus Mirabilis Meningitis in Adults Requiring an Extended Antibiotic Course: Case Report and Literature Review. Cureus. 2023. https:\/\/doi.org\/10.7759\/cureus.39225.","journal-title":"Cureus"},{"key":"13485_CR7","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1186\/1471-2334-13-451","volume":"13","author":"V Pomar","year":"2013","unstructured":"Pomar V, Benito N, L\u00f3pez-Contreras J, Coll P, Gurgu\u00ed M, Domingo P. Spontaneous Gram-Negative Bacillary Meningitis in Adult Patients: Characteristics and Outcome. 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Eur J Clin Microbiol Infect Dis. 2025. https:\/\/doi.org\/10.1007\/s10096-025-05333-z.","journal-title":"Eur J Clin Microbiol Infect Dis"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-026-13485-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-026-13485-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-026-13485-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:25:58Z","timestamp":1782174358000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12879-026-13485-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,4]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["13485"],"URL":"https:\/\/doi.org\/10.1186\/s12879-026-13485-2","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,4]]},"assertion":[{"value":"9 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the University of Debrecen Ethics Committee (approval number: DE RKEB\/IKEB 7200\u2009\u2212\u20092025). All procedures were conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Declaration of Helsinki and its later amendments.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Written informed consent for publication of this case report was obtained from the patient\u2019s next of kin. A copy of the written consent is available for review by the Editor of this journal.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1186"}}