The Accuracy of Molecular Detection Targeting the Mutation C2611T for Detecting Moderate-Level Azithromycin Resistance in <i>Neisseria gonorrhoeae</i>: A Systematic Review and Meta-Analysis
Background: <i>Neisseria gonorrhoeae (N. gonorrhoeae)</i> is now recognized as a commonly reported sexually transmitted pathogen, and the increasing drug resistance of <i>N. gonorrhoeae</i> has become a serious public health problem. The accuracy of molecular detection for de...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-08-01
|
| Series: | Antibiotics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2079-6382/10/9/1027 |
| _version_ | 1797520470508044288 |
|---|---|
| author | Qian Zhou Jingwei Liu Shaochun Chen Wenqi Xu Yan Han Yueping Yin |
| author_facet | Qian Zhou Jingwei Liu Shaochun Chen Wenqi Xu Yan Han Yueping Yin |
| author_sort | Qian Zhou |
| collection | DOAJ |
| description | Background: <i>Neisseria gonorrhoeae (N. gonorrhoeae)</i> is now recognized as a commonly reported sexually transmitted pathogen, and the increasing drug resistance of <i>N. gonorrhoeae</i> has become a serious public health problem. The accuracy of molecular detection for detecting moderate-level azithromycin resistance is not well-established. We summarized the data from studies of the <i>N. gonorrhoeae</i> 23S rRNA mutation at position 2611 with azithromycin resistance to determine the relationship between the mutation and resistance. Methods and Findings: In this systematic review and meta-analysis, two researchers independently searched six databases for studies with data for the azithromycin minimum inhibitory concentrations (MICs) and the 23S rRNA mutation C2611T of each <i>N. gonorrhoeae</i> isolate. Since the breakpoint of moderate-level resistance to azithromycin (ML-AzmR) was not determined, we divided the moderate level into two groups according to the range of MICs (moderate resistance limited to 2–128 mg/L or 4–128 mg/L) for data extraction. A random-effects model was used to calculate the pooled sensitivity rate, the specificity rate, the pooled positive likelihood ratio (PLR), the negative likelihood ratio (NLR), and the diagnostic odds ratio (DOR). Meta-regression analyses by detection method, isolates sampling (a random sample or not), location, and sample size were performed to explore the possible causes of heterogeneity. The potential publication bias of the included studies was conducted by the Deeks’ test. We included 20 studies in our study: 20 studies have data of <i>N. gonorrhoeae</i> with MICs between 2 and 128 mg/L with mutation or without mutation at position 2611(4759 samples), and 14 studies have data of <i>N. gonorrhoeae</i> with MICs between 4 and 128 mg/L (3367 samples). In the group with the moderate level of 2–128 mg/L, the pooled sensitivity rate of the molecular assays was determined to be 71.9% (95% CI, 67.6–74%), the pooled specificity rate was 98.7% (95% CI, 98.2–99.0%), and the DOR ranged from 55.0 to 351.3 (mean, 139.1). In the 4–128 mg/L group, the pooled sensitivity rate was 91.9% (95% CI, 88.9–94.2%), the pooled specificity rate was 95.9% (95% CI, 95.1–96.6%), and the DOR ranged from 41.9 to 364.1 (mean, 123.6). Conclusion: Through this meta-analysis, we found that the C2611T mutation of 23S rRNA is valuable for the molecular diagnostic of moderate-level azithromycin resistance (ML-AzmR) in <i>N. gonorrhoeae</i>, especially when the moderate level is set at 4–128 mg/L. This rapid molecular detection method can be used for the rapid identification of ML-AzmR isolates in the clinic. |
| first_indexed | 2024-03-10T07:57:13Z |
| format | Article |
| id | doaj.art-87cf0fdb29234adeadf4d4c79253beb6 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-10T07:57:13Z |
| publishDate | 2021-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-87cf0fdb29234adeadf4d4c79253beb62023-11-22T11:45:08ZengMDPI AGAntibiotics2079-63822021-08-01109102710.3390/antibiotics10091027The Accuracy of Molecular Detection Targeting the Mutation C2611T for Detecting Moderate-Level Azithromycin Resistance in <i>Neisseria gonorrhoeae</i>: A Systematic Review and Meta-AnalysisQian Zhou0Jingwei Liu1Shaochun Chen2Wenqi Xu3Yan Han4Yueping Yin5National Center for STD Control, Chinese Center for Disease Control and Prevention, Department of Reference STD Lab, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, ChinaNational Center for STD Control, Chinese Center for Disease Control and Prevention, Department of Reference STD Lab, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, ChinaNational Center for STD Control, Chinese Center for Disease Control and Prevention, Department of Reference STD Lab, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, ChinaNational Center for STD Control, Chinese Center for Disease Control and Prevention, Department of Reference STD Lab, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, ChinaNational Center for STD Control, Chinese Center for Disease Control and Prevention, Department of Reference STD Lab, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, ChinaNational Center for STD Control, Chinese Center for Disease Control and Prevention, Department of Reference STD Lab, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, ChinaBackground: <i>Neisseria gonorrhoeae (N. gonorrhoeae)</i> is now recognized as a commonly reported sexually transmitted pathogen, and the increasing drug resistance of <i>N. gonorrhoeae</i> has become a serious public health problem. The accuracy of molecular detection for detecting moderate-level azithromycin resistance is not well-established. We summarized the data from studies of the <i>N. gonorrhoeae</i> 23S rRNA mutation at position 2611 with azithromycin resistance to determine the relationship between the mutation and resistance. Methods and Findings: In this systematic review and meta-analysis, two researchers independently searched six databases for studies with data for the azithromycin minimum inhibitory concentrations (MICs) and the 23S rRNA mutation C2611T of each <i>N. gonorrhoeae</i> isolate. Since the breakpoint of moderate-level resistance to azithromycin (ML-AzmR) was not determined, we divided the moderate level into two groups according to the range of MICs (moderate resistance limited to 2–128 mg/L or 4–128 mg/L) for data extraction. A random-effects model was used to calculate the pooled sensitivity rate, the specificity rate, the pooled positive likelihood ratio (PLR), the negative likelihood ratio (NLR), and the diagnostic odds ratio (DOR). Meta-regression analyses by detection method, isolates sampling (a random sample or not), location, and sample size were performed to explore the possible causes of heterogeneity. The potential publication bias of the included studies was conducted by the Deeks’ test. We included 20 studies in our study: 20 studies have data of <i>N. gonorrhoeae</i> with MICs between 2 and 128 mg/L with mutation or without mutation at position 2611(4759 samples), and 14 studies have data of <i>N. gonorrhoeae</i> with MICs between 4 and 128 mg/L (3367 samples). In the group with the moderate level of 2–128 mg/L, the pooled sensitivity rate of the molecular assays was determined to be 71.9% (95% CI, 67.6–74%), the pooled specificity rate was 98.7% (95% CI, 98.2–99.0%), and the DOR ranged from 55.0 to 351.3 (mean, 139.1). In the 4–128 mg/L group, the pooled sensitivity rate was 91.9% (95% CI, 88.9–94.2%), the pooled specificity rate was 95.9% (95% CI, 95.1–96.6%), and the DOR ranged from 41.9 to 364.1 (mean, 123.6). Conclusion: Through this meta-analysis, we found that the C2611T mutation of 23S rRNA is valuable for the molecular diagnostic of moderate-level azithromycin resistance (ML-AzmR) in <i>N. gonorrhoeae</i>, especially when the moderate level is set at 4–128 mg/L. This rapid molecular detection method can be used for the rapid identification of ML-AzmR isolates in the clinic.https://www.mdpi.com/2079-6382/10/9/1027<i>Neisseria gonorrhoeae</i>23S rRNAazithromycin resistance |
| spellingShingle | Qian Zhou Jingwei Liu Shaochun Chen Wenqi Xu Yan Han Yueping Yin The Accuracy of Molecular Detection Targeting the Mutation C2611T for Detecting Moderate-Level Azithromycin Resistance in <i>Neisseria gonorrhoeae</i>: A Systematic Review and Meta-Analysis Antibiotics <i>Neisseria gonorrhoeae</i> 23S rRNA azithromycin resistance |
| title | The Accuracy of Molecular Detection Targeting the Mutation C2611T for Detecting Moderate-Level Azithromycin Resistance in <i>Neisseria gonorrhoeae</i>: A Systematic Review and Meta-Analysis |
| title_full | The Accuracy of Molecular Detection Targeting the Mutation C2611T for Detecting Moderate-Level Azithromycin Resistance in <i>Neisseria gonorrhoeae</i>: A Systematic Review and Meta-Analysis |
| title_fullStr | The Accuracy of Molecular Detection Targeting the Mutation C2611T for Detecting Moderate-Level Azithromycin Resistance in <i>Neisseria gonorrhoeae</i>: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | The Accuracy of Molecular Detection Targeting the Mutation C2611T for Detecting Moderate-Level Azithromycin Resistance in <i>Neisseria gonorrhoeae</i>: A Systematic Review and Meta-Analysis |
| title_short | The Accuracy of Molecular Detection Targeting the Mutation C2611T for Detecting Moderate-Level Azithromycin Resistance in <i>Neisseria gonorrhoeae</i>: A Systematic Review and Meta-Analysis |
| title_sort | accuracy of molecular detection targeting the mutation c2611t for detecting moderate level azithromycin resistance in i neisseria gonorrhoeae i a systematic review and meta analysis |
| topic | <i>Neisseria gonorrhoeae</i> 23S rRNA azithromycin resistance |
| url | https://www.mdpi.com/2079-6382/10/9/1027 |
| work_keys_str_mv | AT qianzhou theaccuracyofmoleculardetectiontargetingthemutationc2611tfordetectingmoderatelevelazithromycinresistanceinineisseriagonorrhoeaeiasystematicreviewandmetaanalysis AT jingweiliu theaccuracyofmoleculardetectiontargetingthemutationc2611tfordetectingmoderatelevelazithromycinresistanceinineisseriagonorrhoeaeiasystematicreviewandmetaanalysis AT shaochunchen theaccuracyofmoleculardetectiontargetingthemutationc2611tfordetectingmoderatelevelazithromycinresistanceinineisseriagonorrhoeaeiasystematicreviewandmetaanalysis AT wenqixu theaccuracyofmoleculardetectiontargetingthemutationc2611tfordetectingmoderatelevelazithromycinresistanceinineisseriagonorrhoeaeiasystematicreviewandmetaanalysis AT yanhan theaccuracyofmoleculardetectiontargetingthemutationc2611tfordetectingmoderatelevelazithromycinresistanceinineisseriagonorrhoeaeiasystematicreviewandmetaanalysis AT yuepingyin theaccuracyofmoleculardetectiontargetingthemutationc2611tfordetectingmoderatelevelazithromycinresistanceinineisseriagonorrhoeaeiasystematicreviewandmetaanalysis AT qianzhou accuracyofmoleculardetectiontargetingthemutationc2611tfordetectingmoderatelevelazithromycinresistanceinineisseriagonorrhoeaeiasystematicreviewandmetaanalysis AT jingweiliu accuracyofmoleculardetectiontargetingthemutationc2611tfordetectingmoderatelevelazithromycinresistanceinineisseriagonorrhoeaeiasystematicreviewandmetaanalysis AT shaochunchen accuracyofmoleculardetectiontargetingthemutationc2611tfordetectingmoderatelevelazithromycinresistanceinineisseriagonorrhoeaeiasystematicreviewandmetaanalysis AT wenqixu accuracyofmoleculardetectiontargetingthemutationc2611tfordetectingmoderatelevelazithromycinresistanceinineisseriagonorrhoeaeiasystematicreviewandmetaanalysis AT yanhan accuracyofmoleculardetectiontargetingthemutationc2611tfordetectingmoderatelevelazithromycinresistanceinineisseriagonorrhoeaeiasystematicreviewandmetaanalysis AT yuepingyin accuracyofmoleculardetectiontargetingthemutationc2611tfordetectingmoderatelevelazithromycinresistanceinineisseriagonorrhoeaeiasystematicreviewandmetaanalysis |