Molecular Tools for Guiding Therapy in Patients With Staphylococcal Bone and Joint Infections: A Diagnostic Test Accuracy Meta-analysis
BackgroundTimely detection of causative pathogens and their antimicrobial resistance are essential for guiding targeted therapies in bone and joint infections (BJI) patients. We performed a systematic review and meta-analysis to assess the diagnostic value of testing osteoarticular samples with the...
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Frontiers Media S.A.
2022-07-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2022.792679/full |
| _version_ | 1818532478519869440 |
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| author | Ke Chen Ke Chen Yanqiu Wang Yue Yuan Wen Qin 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 Yanqiu Wang Yue Yuan Wen Qin 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 | BackgroundTimely detection of causative pathogens and their antimicrobial resistance are essential for guiding targeted therapies in bone and joint infections (BJI) patients. We performed a systematic review and meta-analysis to assess the diagnostic value of testing osteoarticular samples with the nucleic acid amplification tests (NAAT) for effective staphylococcal strain identification and the administration of appropriately targeted antimicrobial agents in BJI patients.MethodsFive databases, including PubMed, Embase, Scopus, Web of Science, and the Cochrane Library, were searched for related publications from inception to July 24, 2021. Studies comparing the diagnostic accuracy of NAAT to a microbiological culture reference standard of osteoarticular specimens were eligible. Pooled summary values of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) of NAAT compared to the microbiological culture reference standard were calculated using bivariate random-effects meta-analyses.ResultsFrom 906 citations, 11 studies were included. Eleven studies comprising 13 datasets (n = 1047) evaluated NAAT accuracy for methicillin-sensitive Staphylococcus aureus (MSSA) identification, while seven studies comprising nine datasets (n = 727) evaluated methicillin-resistant Staphylococcus aureus (MRSA) identification. Against the microbiological culture reference standard, the pooled summary estimates for detection of both MSSA [sensitivity: 0.89 (95% confidence interval [CI] 0.84–0.93), specificity: 0.99 (95% CI 0.97–0.99), PLR: 34.13 (95% CI 20.54–56.73), NLR: 0.19 (95% CI 0.12–0.3), and DOR: 283.37 (95% CI 129.49–620.1)] and MRSA [sensitivity: 0.81 (95% CI 0.67–0.91), specificity: 1.0 (95% CI 0.99–1.0), PLR: 62.1 (95% CI 24.5–157.6), NLR: 0.33 (95% CI 0.16–0.69), and DOR: 300.25 (95% CI 85.01–1060.5)] were comparable. Heterogeneity was moderate. GeneXpert was frequently used among NAA tests, and its diagnostic accuracy was in line with the overall pooled summary estimates. The heterogeneity in diagnostic efficacy (P >0.05) could not be explained by a meta-regression and subgroup analysis of the research design, sample condition, and patient selection technique.ConclusionsOur study suggested that NAAT can be applied as the preferred prescreening test for the timely diagnosis of staphylococcal strains associated with BJI in osteoarticular samples for successful antimicrobial therapy. |
| first_indexed | 2024-12-11T17:46:03Z |
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| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-12-11T17:46:03Z |
| publishDate | 2022-07-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Endocrinology |
| spelling | doaj.art-e8db99eff5b048899f5ffc6b9fd371452022-12-22T00:56:22ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922022-07-011310.3389/fendo.2022.792679792679Molecular Tools for Guiding Therapy in Patients With Staphylococcal Bone and Joint Infections: A Diagnostic Test Accuracy Meta-analysisKe Chen0Ke Chen1Yanqiu Wang2Yue Yuan3Wen Qin4Yun-Jian Sheng5Yun-Jian Sheng6Sarfraz Ahmed7Changfeng Sun8Changfeng Sun9Cun-Liang Deng10Suvash Chandra Ojha11Suvash Chandra Ojha12Department 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, 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, 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, ChinaBackgroundTimely detection of causative pathogens and their antimicrobial resistance are essential for guiding targeted therapies in bone and joint infections (BJI) patients. We performed a systematic review and meta-analysis to assess the diagnostic value of testing osteoarticular samples with the nucleic acid amplification tests (NAAT) for effective staphylococcal strain identification and the administration of appropriately targeted antimicrobial agents in BJI patients.MethodsFive databases, including PubMed, Embase, Scopus, Web of Science, and the Cochrane Library, were searched for related publications from inception to July 24, 2021. Studies comparing the diagnostic accuracy of NAAT to a microbiological culture reference standard of osteoarticular specimens were eligible. Pooled summary values of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) of NAAT compared to the microbiological culture reference standard were calculated using bivariate random-effects meta-analyses.ResultsFrom 906 citations, 11 studies were included. Eleven studies comprising 13 datasets (n = 1047) evaluated NAAT accuracy for methicillin-sensitive Staphylococcus aureus (MSSA) identification, while seven studies comprising nine datasets (n = 727) evaluated methicillin-resistant Staphylococcus aureus (MRSA) identification. Against the microbiological culture reference standard, the pooled summary estimates for detection of both MSSA [sensitivity: 0.89 (95% confidence interval [CI] 0.84–0.93), specificity: 0.99 (95% CI 0.97–0.99), PLR: 34.13 (95% CI 20.54–56.73), NLR: 0.19 (95% CI 0.12–0.3), and DOR: 283.37 (95% CI 129.49–620.1)] and MRSA [sensitivity: 0.81 (95% CI 0.67–0.91), specificity: 1.0 (95% CI 0.99–1.0), PLR: 62.1 (95% CI 24.5–157.6), NLR: 0.33 (95% CI 0.16–0.69), and DOR: 300.25 (95% CI 85.01–1060.5)] were comparable. Heterogeneity was moderate. GeneXpert was frequently used among NAA tests, and its diagnostic accuracy was in line with the overall pooled summary estimates. The heterogeneity in diagnostic efficacy (P >0.05) could not be explained by a meta-regression and subgroup analysis of the research design, sample condition, and patient selection technique.ConclusionsOur study suggested that NAAT can be applied as the preferred prescreening test for the timely diagnosis of staphylococcal strains associated with BJI in osteoarticular samples for successful antimicrobial therapy.https://www.frontiersin.org/articles/10.3389/fendo.2022.792679/fullbone and joint infectionNAAT accuracyanti-staphylococcal therapysystematic reviewmeta-analysis |
| spellingShingle | Ke Chen Ke Chen Yanqiu Wang Yue Yuan Wen Qin Yun-Jian Sheng Yun-Jian Sheng Sarfraz Ahmed Changfeng Sun Changfeng Sun Cun-Liang Deng Suvash Chandra Ojha Suvash Chandra Ojha Molecular Tools for Guiding Therapy in Patients With Staphylococcal Bone and Joint Infections: A Diagnostic Test Accuracy Meta-analysis Frontiers in Endocrinology bone and joint infection NAAT accuracy anti-staphylococcal therapy systematic review meta-analysis |
| title | Molecular Tools for Guiding Therapy in Patients With Staphylococcal Bone and Joint Infections: A Diagnostic Test Accuracy Meta-analysis |
| title_full | Molecular Tools for Guiding Therapy in Patients With Staphylococcal Bone and Joint Infections: A Diagnostic Test Accuracy Meta-analysis |
| title_fullStr | Molecular Tools for Guiding Therapy in Patients With Staphylococcal Bone and Joint Infections: A Diagnostic Test Accuracy Meta-analysis |
| title_full_unstemmed | Molecular Tools for Guiding Therapy in Patients With Staphylococcal Bone and Joint Infections: A Diagnostic Test Accuracy Meta-analysis |
| title_short | Molecular Tools for Guiding Therapy in Patients With Staphylococcal Bone and Joint Infections: A Diagnostic Test Accuracy Meta-analysis |
| title_sort | molecular tools for guiding therapy in patients with staphylococcal bone and joint infections a diagnostic test accuracy meta analysis |
| topic | bone and joint infection NAAT accuracy anti-staphylococcal therapy systematic review meta-analysis |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2022.792679/full |
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