Tehran University of Medical Sciences Journal of Medical Bacteriology 2251-8649 13 4 2025 12 12 45 55 Sheetal Goenka G.B.Pant Hospital Wanshisha Wanswett 0009-0007-4773-6145 Abha Sharma 0000-0001-9691-3338 Poonam Loomba 0000-0002-5580-5733 Manisha Jain 0000-0002-6976-3853 Shivani Tyagi 0000-0002-1276-0133 2025 08 12 2025 08 28 Background:    Central nervous system (CNS) infections are life-threatening medical emergencies requiring rapid and accurate diagnosis. This prospective study compared the BioFire Meningitis/Encephalitis (ME) Panel with conventional diagnostics in suspected cases. Methods:   We conducted a single-center, prospective study at GB Pant Hospital from January to December 2024, enrolling 100 consecutive patients with clinical suspicion of meningitis or encephalitis. Cerebrospinal fluid (CSF) samples were simultaneously analysed using the BioFire ME Panel and conventional diagnostic methods (culture, Gram stain, cytology). Clinical data including demographics, risk factors, prior antimicrobial therapy, and outcomes were recorded. Results:   The BioFire ME Panel detected pathogens in 7% (7/100) of cases, comprising Streptococcus pneumoniae (n=2), Haemophilus influenzae (n=1), Escherichia coli K1 (n=1), herpes simplex virus (n=2), and cytomegalovirus (n=1). In two culture-negative cases with prior antibiotic exposure, the panel successfully identified bacterial pathogens despite negative Gram stain results. The panel demonstrated excellent diagnostic performance (sensitivity 100%, specificity 98.9%, PPV 87.5%, NPV 100%) with a median time-to-result of 65 minutes versus 72 hours for conventional cultures. Implementation of the panel led to therapy modifications in 71.4% (5/7) of positive cases, including de-escalation of empiric therapy in 3 cases and targeted antiviral initiation in 2 cases. Conclusion:   The BioFire ME Panel demonstrates superior diagnostic utility in CNS infection diagnosis, particularly in culture-negative cases with prior antimicrobial exposure. Its rapid turnaround time facilitates prompt clinical decision-making and appropriate antimicrobial stewardship, suggesting significant value as a complementary diagnostic tool in the management of suspected meningitis and encephalitis. https://jmb.tums.ac.ir/index.php/jmb/article/view/601