Nursing Research Institute, University of Ulster, Belfast, UK.
Clin Microbiol Infect. 2011 Feb;17(2):146-54. doi: 10.1111/j.1469-0691.2010.03202.x.
A systematic review and meta-analysis were performed to determine and compare the sensitivity and specificity of PCR-based and culture-based diagnostic tests for methicillin-resistant Staphylococcus aureus (MRSA). Our analysis included 74 accuracy measurements from 29 publications. Nine tests were evaluated: the PCR-based Genotype MRSA Direct and IDI-MRSA, the chromogenic media CHROMagar, Chromogenic MRSA Medium, MRSA ID, MRSA Select and ORSAB, and the nonchromogenic culture media MSA-Cefoxitin and MSA-Oxacillin. For four chromogenic media, incubation periods of 18-24 and 48 h were evaluated. Considerable heterogeneity was detected in most analyses. A significantly higher sensitivity was found for the overall PCR pooled estimate (92.5; 95% CI 87.4-95.9) and the chromogenic media after 48 h of incubation (87.6; 95% CI 82.1-91.6) compared to the overall sensitivity of chromogenic media after 18-24 h (78.3; 95% CI 71.0-84.1). The specificity of chromogenic media after 18-24 h (98.6; 95% CI 97.7-99.1) was higher than the specificity of PCR (97.0; 95% CI 94.5-98.4) but declined after 48 h of incubation (94.7; 95% CI 91.6-96.8).The most sensitive chromogenic medium after 18-24 h of incubation was Chromogenic MRSA Medium (sensitivity: 89.3; 95% CI 72.8-96.3), whereas the most specific chromogenic medium after 18-24 h of incubation was MRSA Select (specificity: 99.4; 95% CI 98.6-99.7). After 48 h of incubation, MRSA Select had the highest sensitivity (93.2; 95% CI 83.5-97.0), whereas CHROMagar had the highest specificity (96.4; 95% CI 91.3-98.5). This meta-analysis showed statistically significant differences in diagnostic accuracy between several of the tests and the test methods evaluated. A reduction of the incubation time of chromogenic media (from 48 to 18-24 h) increases specificity but reduces sensitivity.
本研究通过系统回顾和荟萃分析，旨在评估并比较聚合酶链反应（PCR）和基于培养的诊断检测方法在检测耐甲氧西林金黄色葡萄球菌（MRSA）中的敏感性和特异性。我们的分析共纳入了 29 篇文献中的 74 项准确性测量指标。共评估了 9 种检测方法：基于 PCR 的 Genotype MRSA Direct 和 IDI-MRSA、显色培养基 CHROMagar、显色 MRSA 培养基、MRSA ID、MRSA Select 和 ORSAB，以及非显色培养基 MSA-Cefoxitin 和 MSA-Oxacillin。对于四种显色培养基，评估了 18-24 小时和 48 小时的孵育期。大多数分析中均检测到了显著的异质性。总体而言，PCR 汇总估计值（92.5%；95%置信区间 87.4-95.9）和孵育 48 小时后的显色培养基（87.6%；95%置信区间 82.1-91.6）的敏感性显著高于孵育 18-24 小时后的显色培养基（78.3%；95%置信区间 71.0-84.1）。孵育 18-24 小时后的显色培养基（98.6%；95%置信区间 97.7-99.1）的特异性高于 PCR（97.0%；95%置信区间 94.5-98.4），但孵育 48 小时后特异性下降（94.7%；95%置信区间 91.6-96.8）。孵育 18-24 小时后最敏感的显色培养基是显色 MRSA 培养基（敏感性：89.3%；95%置信区间 72.8-96.3），而孵育 18-24 小时后最特异的显色培养基是 MRSA Select（特异性：99.4%；95%置信区间 98.6-99.7）。孵育 48 小时后，MRSA Select 的敏感性最高（93.2%；95%置信区间 83.5-97.0），而 CHROMagar 的特异性最高（96.4%；95%置信区间 91.3-98.5）。本荟萃分析显示，几种检测方法和评估的检测方法在诊断准确性方面存在统计学显著差异。缩短显色培养基的孵育时间（从 48 小时减少至 18-24 小时）可提高特异性，但降低敏感性。
