Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
Departments of Epidemiology, Global Health, and Center for AIDS and STD, University of Washington, Seattle, Washington, USA.
J Clin Microbiol. 2019 Oct 23;57(11). doi: 10.1128/JCM.01125-19. Print 2019 Nov.
A prospective multicenter clinical study involving subjects from 21 sites across the United States was conducted to validate the performance of a new diagnostic nucleic acid amplification test (NAAT) for the detection of Seven urogenital specimen types ( = 11,556) obtained from 1,778 females, aged 15 to 74 years, and 1,583 males, aged 16 to 82 years, were tested with the Aptima assay, an investigational transcription-mediated amplification (TMA) NAAT for the detection of 16S rRNA. Infected status for enrolled subjects was established using results obtained from testing either self-collected vaginal swab or clinician-collected male urethral swab specimens with a composite reference method consisting of three transcription-mediated amplification NAATs targeting unique regions of 16S or 23S rRNA. prevalence was 10.2% in females and 10.6% in males; prevalence was high in both symptomatic and asymptomatic subjects for both sexes. Compared to the subject infected status standard, the investigational test had sensitivity and specificity estimates, respectively, of 98.9% and 98.5% for subject-collected vaginal swabs, 92.0% and 98.0% for clinician-collected vaginal swabs, 81.5% and 98.3% for endocervical swabs, 77.8% and 99.0% for female urine, and 98.2% and 99.6% for male urethral swabs, 88.4% and 97.8% for self-collected penile meatal swabs, and 90.9% and 99.4% for male urine specimens. For all seven specimen types, within-specimen positive and negative agreements between the investigational test and the composite reference standard ranged from 94.2% to 98.3% and from 98.5 to 99.9%, respectively. These results provide clinical efficacy evidence for the first FDA-cleared NAAT for detection in the United States.
一项涉及美国 21 个地点的受试者的前瞻性多中心临床研究旨在验证一种新的诊断核酸扩增检测(NAAT)在检测七种泌尿生殖道标本类型(共 11556 份)中的性能,这些标本来自 1778 名年龄在 15 至 74 岁的女性和 1583 名年龄在 16 至 82 岁的男性。这些标本均使用 Aptima 检测法(一种用于检测 16S rRNA 的实验性转录介导扩增(TMA)NAAT)进行了检测。通过使用三种针对 16S 或 23S rRNA 独特区域的转录介导扩增(TMA)NAAT 的复合参考方法,对入组受试者的感染状态进行了检测,该方法包括自我采集的阴道拭子或临床医生采集的男性尿道拭子。女性的感染率为 10.2%,男性为 10.6%;无论男女,无论有无症状,感染率均较高。与受试者感染状态的标准相比,研究性检测法对自我采集的阴道拭子的敏感性和特异性估计值分别为 98.9%和 98.5%,对临床医生采集的阴道拭子的敏感性和特异性估计值分别为 92.0%和 98.0%,对宫颈拭子的敏感性和特异性估计值分别为 81.5%和 98.3%,对女性尿液的敏感性和特异性估计值分别为 77.8%和 99.0%,对男性尿道拭子的敏感性和特异性估计值分别为 98.2%和 99.6%,对自我采集的阴茎尿道拭子的敏感性和特异性估计值分别为 88.4%和 97.8%,对男性尿液标本的敏感性和特异性估计值分别为 90.9%和 99.4%。对于所有七种标本类型,研究性检测法与复合参考标准在同一样本中的阳性和阴性符合率分别为 94.2%至 98.3%和 98.5%至 99.9%。这些结果为美国首个获得 FDA 批准的用于检测的 NAAT 提供了临床疗效证据。