European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; Immunisation, Hepatitis & Blood Safety Department, Public Health England, London, United Kingdom.
J Infect. 2013 Nov;67(5):385-90. doi: 10.1016/j.jinf.2013.06.007. Epub 2013 Jun 22.
In England, national guidance recommends that all patients with suspected invasive meningococcal disease (IMD) should be investigated by blood culture and polymerase chain reaction (PCR) testing. The Meningococcal Reference Unit (MRU) provides a national service for meningococcal species confirmation and PCR-testing of clinical samples. We performed a population-level assessment of the added value of PCR-testing for IMD to augment traditional culture confirmation.
We analysed all PCR-samples and invasive meningococcal isolates received by MRU in 2009 and 2010. We assumed that all patients with PCR-samples submitted to MRU also had blood cultures performed and that positive blood cultures were referred to MRU. We confirmed this assertion by case ascertainment.
In total, 25,379 specimens from 22,039 patients were submitted for PCR-testing and 1492 (6.8%) tested PCR-positive. MRU received 825 invasive meningococcal isolates; 393 confirmed by PCR and culture, 405 without a PCR-specimen submitted and 27 with a PCR-negative result. Thus, of 1924 reported IMD cases, 1099 (57.1%) were confirmed by PCR only, 432 (22.5%) by culture only and 393 (20.4%) by both tests.
More than half of all confirmed IMD cases were confirmed by PCR only, indicating this service ensures high case ascertainment for national surveillance.
在英国，国家指南建议所有疑似侵袭性脑膜炎球菌病（IMD）的患者均应通过血液培养和聚合酶链反应（PCR）检测进行检查。脑膜炎球菌参考单位（MRU）为脑膜炎球菌种属确认和临床样本的 PCR 检测提供了全国性服务。我们对 PCR 检测对 IMD 的附加价值进行了人群水平评估，以补充传统的培养确认。
我们分析了 2009 年和 2010 年 MRU 收到的所有 PCR 样本和侵袭性脑膜炎球菌分离株。我们假设所有提交给 MRU 的 PCR 样本的患者都进行了血液培养，并且阳性血液培养物都被送到了 MRU。我们通过病例确定来证实这一说法。
总共 22039 名患者的 25379 份标本进行了 PCR 检测，其中 1492 份（6.8%）检测为 PCR 阳性。MRU 收到了 825 株侵袭性脑膜炎球菌分离株；其中 393 株通过 PCR 和培养得到确认，405 株未提交 PCR 样本，27 株 PCR 结果为阴性。因此，在报告的 1924 例 IMD 病例中，1099 例（57.1%）仅通过 PCR 确认，432 例（22.5%）仅通过培养确认，393 例（20.4%）通过两种检测方法确认。
超过一半的确诊 IMD 病例仅通过 PCR 确认，这表明该服务可确保全国监测中的高病例检出率。
