Clinical Utility of Molecular Tests for Guiding Therapeutic Decisions in Bloodstream Staphylococcal Infections: A Meta-Analysis
Background: Treatment of bloodstream staphylococcal infections (BSI) necessitates the prompt initiation of appropriate antimicrobial agents and the rapid de-escalation of excessive broad-spectrum coverage to reduce the risk of mortality. We, therefore, aimed to demonstrate the diagnostic accuracy of...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-08-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2021.713447/full |
| _version_ | 1818643689997598720 |
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| author | Ke Chen Ke Chen Aijaz Ahmad Malik Yun-Jian Sheng Yun-Jian Sheng Sarfraz Ahmed Changfeng Sun Changfeng Sun Cun-Liang Deng Suvash Chandra Ojha Suvash Chandra Ojha |
| author_facet | Ke Chen Ke Chen Aijaz Ahmad Malik Yun-Jian Sheng Yun-Jian Sheng Sarfraz Ahmed Changfeng Sun Changfeng Sun Cun-Liang Deng Suvash Chandra Ojha Suvash Chandra Ojha |
| author_sort | Ke Chen |
| collection | DOAJ |
| description | Background: Treatment of bloodstream staphylococcal infections (BSI) necessitates the prompt initiation of appropriate antimicrobial agents and the rapid de-escalation of excessive broad-spectrum coverage to reduce the risk of mortality. We, therefore, aimed to demonstrate the diagnostic accuracy of nucleic acid amplification tests (NAAT) for the identification of methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) in clinically suspected patients.Methods: Until November 23, 2020, databases including PubMed, Scopus, Embase, and Web of Science were scanned for eligible studies. A bivariate random-effects model was used for meta-analysis of the 33 included studies obtained from 1606 citations, and pooled summary estimates with 95% confidence intervals (CI) were generated.Results: Twenty-three studies (n = 8,547) assessed NAAT accuracy for MSSA detection, while three studies (n = 479) evaluated MRSA detection in adults. The pooled NAAT sensitivity and specificity for MRSA in adults was higher [sensitivity: 0.83 (95% CI 0.59–0.96), specificity: 0.99 (95% CI 0.98–1.0)] as compared to MSSA [sensitivity: 0.76 (95% CI 0.69–0.82), specificity: 0.98 (95% CI 0.98–0.99)]. Similarly, eight studies (n = 4,089) investigating MSSA in pediatric population reported higher NAAT accuracy [sensitivity: 0.89 (95% CI 0.76–0.96), specificity: 0.98 (95% CI 0.97–0.98)] compared to adults. Among NAA tests, SeptiFast (real-time PCR, commercial) was frequently applied, and its diagnostic accuracy corresponded well to the overall summary estimates. A meta-regression and subgroup analysis of study design, sample condition, and patient selection method could not explain the heterogeneity (P > 0.05) in the diagnostic efficiency.Conclusions: NAAT could be applied as the preferred initial tests for timely diagnosis and BSI management. |
| first_indexed | 2024-12-17T00:02:57Z |
| format | Article |
| id | doaj.art-821cd221d760412c9b828d07967307f5 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-12-17T00:02:57Z |
| publishDate | 2021-08-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pediatrics |
| spelling | doaj.art-821cd221d760412c9b828d07967307f52022-12-21T22:11:02ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602021-08-01910.3389/fped.2021.713447713447Clinical Utility of Molecular Tests for Guiding Therapeutic Decisions in Bloodstream Staphylococcal Infections: A Meta-AnalysisKe Chen0Ke Chen1Aijaz Ahmad Malik2Yun-Jian Sheng3Yun-Jian Sheng4Sarfraz Ahmed5Changfeng Sun6Changfeng Sun7Cun-Liang Deng8Suvash Chandra Ojha9Suvash Chandra Ojha10Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, ChinaSouthwest Medical University, Luzhou, ChinaFaculty of Medical Technology, Center of Data Mining and Biomedical Informatics, Mahidol University, Bangkok, ThailandDepartment of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, ChinaSouthwest Medical University, Luzhou, ChinaDepartment of Basic Sciences, University of Veterinary and Animal Sciences Lahore, Narowal, PakistanDepartment of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, ChinaSouthwest Medical University, Luzhou, ChinaDepartment of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, ChinaDepartment of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, ChinaSouthwest Medical University, Luzhou, ChinaBackground: Treatment of bloodstream staphylococcal infections (BSI) necessitates the prompt initiation of appropriate antimicrobial agents and the rapid de-escalation of excessive broad-spectrum coverage to reduce the risk of mortality. We, therefore, aimed to demonstrate the diagnostic accuracy of nucleic acid amplification tests (NAAT) for the identification of methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) in clinically suspected patients.Methods: Until November 23, 2020, databases including PubMed, Scopus, Embase, and Web of Science were scanned for eligible studies. A bivariate random-effects model was used for meta-analysis of the 33 included studies obtained from 1606 citations, and pooled summary estimates with 95% confidence intervals (CI) were generated.Results: Twenty-three studies (n = 8,547) assessed NAAT accuracy for MSSA detection, while three studies (n = 479) evaluated MRSA detection in adults. The pooled NAAT sensitivity and specificity for MRSA in adults was higher [sensitivity: 0.83 (95% CI 0.59–0.96), specificity: 0.99 (95% CI 0.98–1.0)] as compared to MSSA [sensitivity: 0.76 (95% CI 0.69–0.82), specificity: 0.98 (95% CI 0.98–0.99)]. Similarly, eight studies (n = 4,089) investigating MSSA in pediatric population reported higher NAAT accuracy [sensitivity: 0.89 (95% CI 0.76–0.96), specificity: 0.98 (95% CI 0.97–0.98)] compared to adults. Among NAA tests, SeptiFast (real-time PCR, commercial) was frequently applied, and its diagnostic accuracy corresponded well to the overall summary estimates. A meta-regression and subgroup analysis of study design, sample condition, and patient selection method could not explain the heterogeneity (P > 0.05) in the diagnostic efficiency.Conclusions: NAAT could be applied as the preferred initial tests for timely diagnosis and BSI management.https://www.frontiersin.org/articles/10.3389/fped.2021.713447/fullbloodstream infectionNAAT accuracystaphylococcal infectionspediatric populationmeta-analysis |
| spellingShingle | Ke Chen Ke Chen Aijaz Ahmad Malik Yun-Jian Sheng Yun-Jian Sheng Sarfraz Ahmed Changfeng Sun Changfeng Sun Cun-Liang Deng Suvash Chandra Ojha Suvash Chandra Ojha Clinical Utility of Molecular Tests for Guiding Therapeutic Decisions in Bloodstream Staphylococcal Infections: A Meta-Analysis Frontiers in Pediatrics bloodstream infection NAAT accuracy staphylococcal infections pediatric population meta-analysis |
| title | Clinical Utility of Molecular Tests for Guiding Therapeutic Decisions in Bloodstream Staphylococcal Infections: A Meta-Analysis |
| title_full | Clinical Utility of Molecular Tests for Guiding Therapeutic Decisions in Bloodstream Staphylococcal Infections: A Meta-Analysis |
| title_fullStr | Clinical Utility of Molecular Tests for Guiding Therapeutic Decisions in Bloodstream Staphylococcal Infections: A Meta-Analysis |
| title_full_unstemmed | Clinical Utility of Molecular Tests for Guiding Therapeutic Decisions in Bloodstream Staphylococcal Infections: A Meta-Analysis |
| title_short | Clinical Utility of Molecular Tests for Guiding Therapeutic Decisions in Bloodstream Staphylococcal Infections: A Meta-Analysis |
| title_sort | clinical utility of molecular tests for guiding therapeutic decisions in bloodstream staphylococcal infections a meta analysis |
| topic | bloodstream infection NAAT accuracy staphylococcal infections pediatric population meta-analysis |
| url | https://www.frontiersin.org/articles/10.3389/fped.2021.713447/full |
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