Publication: Clinical Utility of Molecular Tests for Guiding Therapeutic Decisions in Bloodstream Staphylococcal Infections: A Meta-Analysis
Issued Date
2021-08-05
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ISSN
22962360
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2-s2.0-85113310106
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Mahidol University
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SCOPUS
Bibliographic Citation
Frontiers in Pediatrics. Vol.9, (2021)
Suggested Citation
Ke Chen, Aijaz Ahmad Malik, Yun Jian Sheng, Sarfraz Ahmed, Changfeng Sun, Cun Liang Deng, Suvash Chandra Ojha Clinical Utility of Molecular Tests for Guiding Therapeutic Decisions in Bloodstream Staphylococcal Infections: A Meta-Analysis. Frontiers in Pediatrics. Vol.9, (2021). doi:10.3389/fped.2021.713447 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/77974
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Title
Clinical Utility of Molecular Tests for Guiding Therapeutic Decisions in Bloodstream Staphylococcal Infections: A Meta-Analysis
Abstract
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.