Ojha Suvash Chandra, Chen Ke, Sun Changfeng, Ahmed Sarfraz, Sheng Yun-Jian, Deng Cun-Liang
Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China.
Southwest Medical University, Jiangyang District, Luzhou, 646000, China.
Infect Dis Ther. 2022 Jun;11(3):1205-1227. doi: 10.1007/s40121-022-00632-w. Epub 2022 Apr 22.
Rapid identification of the causal organism and antibiotic resistance is crucial for guiding targeted therapy in patients with suspected staphylococcal infection. A meta-analysis was carried out to evaluate the diagnostic relevance of Xpert™ MRSA/SA (Xpert) from clinical samples of various origins for limiting the use of unnecessary empirical methicillin-resistant Staphylococcus aureus (MRSA) therapy.
Five databases, including the Cochrane Library, Scopus, PubMed, Web of Science, and Embase, were comprehensively inspected from inception to October 12, 2021. The pooled summary estimates were evaluated using a bivariate random-effects model.
Our inclusion criteria were met by 49 publications containing 68 datasets out of 735 citations. A total of 21 studies (n = 4996) examined the accuracy of Xpert in detecting methicillin-sensitive S. aureus (MSSA), while 47 studies (n = 45,430) examined the accuracy of Xpert in detecting MRSA. As compared to MRSA, Xpert's diagnostic performance for MSSA detection was markedly higher [sensitivity: 0.97 (0.96-0.98), specificity: 0.97 (0.97-0.98), area under curve (AUC): 0.99 (0.99-1.0)]. Xpert's pooled sensitivity and specificity differed marginally across sample types, including screening of colonization, lower respiratory tract (LRT), osteoarticular, and bloodstream samples. Notably, the Xpert pooled specificity was consistently ≥ 92% against microbiological culture across all sample types. The diagnostic efficiency heterogeneity was not explained by a meta-regression and subgroup analysis of research design, sample conditions, and sampling methods (P > 0.05).
Our findings suggest that Xpert could be used as the favoured screening test for the early detection of staphylococcal infection in a variety of sample types, with the goal of guiding therapeutic decisions.
快速鉴定病原体及抗生素耐药性对于指导疑似葡萄球菌感染患者的靶向治疗至关重要。开展了一项荟萃分析，以评估Xpert™ MRSA/SA（Xpert）在各种来源临床样本中的诊断相关性，以限制不必要的经验性耐甲氧西林金黄色葡萄球菌（MRSA）治疗的使用。
全面检索了包括Cochrane图书馆、Scopus、PubMed、Web of Science和Embase在内的五个数据库，检索时间从建库至2021年10月12日。使用双变量随机效应模型评估汇总的总结估计值。
735篇文献中有49篇包含68个数据集符合我们的纳入标准。共有21项研究（n = 4996）检测了Xpert检测甲氧西林敏感金黄色葡萄球菌（MSSA）的准确性，47项研究（n = 45430）检测了Xpert检测MRSA的准确性。与MRSA相比，Xpert检测MSSA的诊断性能明显更高[敏感性：0.97（0.96 - 0.98），特异性：0.97（0.97 - 0.98），曲线下面积（AUC）：0.99（0.99 - 1.0）]。Xpert的汇总敏感性和特异性在不同样本类型（包括定植筛查、下呼吸道（LRT）、骨关节和血液样本）中略有差异。值得注意的是，在所有样本类型中，Xpert针对微生物培养的汇总特异性始终≥92%。研究设计、样本条件和采样方法的meta回归和亚组分析无法解释诊断效率的异质性（P > 0.05）。
我们的研究结果表明，Xpert可作为在各种样本类型中早期检测葡萄球菌感染的首选筛查试验，以指导治疗决策。
