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Title: Defining the true sensitivity of culture for the diagnosis of melioidosis using Bayesian latent class models
Authors: Direk Limmathurotsakul
Kris Jamsen
Arkhom Arayawichanont
Julie A. Simpson
Lisa J. White
Sue J. Lee
Vanaporn Wuthiekanun
Narisara Chantratita
Allen Cheng
Nicholas P.J. Day
Claudio Verzilli
Sharon J. Peacock
Mahidol University
University of Melbourne
Sappasitthiprasong Hospital
Nuffield Department of Clinical Medicine
Monash University
Menzies School of Health Research
London School of Hygiene & Tropical Medicine
University of Cambridge
Keywords: Agricultural and Biological Sciences;Biochemistry, Genetics and Molecular Biology
Issue Date: 21-Oct-2010
Citation: PLoS ONE. Vol.5, No.8 (2010)
Abstract: Background: Culture remains the diagnostic gold standard for many bacterial infections, and the method against which other tests are often evaluated. Specificity of culture is 100% if the pathogenic organism is not found in healthy subjects, but the sensitivity of culture is more difficult to determine and may be low. Here, we apply Bayesian latent class models (LCMs) to data from patients with a single Gram-negative bacterial infection and define the true sensitivity of culture together with the impact of misclassification by culture on the reported accuracy of alternative diagnostic tests. Methods/Principal Findings: Data from published studies describing the application of five diagnostic tests (culture and four serological tests) to a patient cohort with suspected melioidosis were re-analysed using several Bayesian LCMs. Sensitivities, specificities, and positive and negative predictive values (PPVs and NPVs) were calculated. Of 320 patients with suspected melioidosis, 119 (37%) had culture confirmed melioidosis. Using the final model (Bayesian LCM with conditional dependence between serological tests), the sensitivity of culture was estimated to be 60.2%. Prediction accuracy of the final model was assessed using a classification tool to grade patients according to the likelihood of melioidosis, which indicated that an estimated disease prevalence of 61.6% was credible. Estimates of sensitivities, specificities, PPVs and NPVs of four serological tests were significantly different from previously published values in which culture was used as the gold standard. Conclusions/Significance: Culture has low sensitivity and low NPV for the diagnosis of melioidosis and is an imperfect gold standard against which to evaluate alternative tests. Models should be used to support the evaluation of diagnostic tests with an imperfect gold standard. It is likely that the poor sensitivity/specificity of culture is not specific for melioidosis, but rather a generic problem for many bacterial and fungal infections. © 2010 Limmathurotsakul et al.
ISSN: 19326203
Appears in Collections:Scopus 2006-2010

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