Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Southwest Medical University, Luzhou, China.
Front Endocrinol (Lausanne). 2022 Jul 13;13:792679. doi: 10.3389/fendo.2022.792679. eCollection 2022.
Timely detection of causative pathogens and their antimicrobial resistance are essential for guiding targeted therapies in bone and joint infections (BJI) patients. We performed a systematic review and meta-analysis to assess the diagnostic value of testing osteoarticular samples with the nucleic acid amplification tests (NAAT) for effective staphylococcal strain identification and the administration of appropriately targeted antimicrobial agents in BJI patients.
Five databases, including PubMed, Embase, Scopus, Web of Science, and the Cochrane Library, were searched for related publications from inception to July 24, 2021. Studies comparing the diagnostic accuracy of NAAT to a microbiological culture reference standard of osteoarticular specimens were eligible. Pooled summary values of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) of NAAT compared to the microbiological culture reference standard were calculated using bivariate random-effects meta-analyses.
From 906 citations, 11 studies were included. Eleven studies comprising 13 datasets ( = 1047) evaluated NAAT accuracy for methicillin-sensitive (MSSA) identification, while seven studies comprising nine datasets ( = 727) evaluated methicillin-resistant (MRSA) identification. Against the microbiological culture reference standard, the pooled summary estimates for detection of both MSSA [sensitivity: 0.89 (95% confidence interval [CI] 0.84-0.93), specificity: 0.99 (95% CI 0.97-0.99), PLR: 34.13 (95% CI 20.54-56.73), NLR: 0.19 (95% CI 0.12-0.3), and DOR: 283.37 (95% CI 129.49-620.1)] and MRSA [sensitivity: 0.81 (95% CI 0.67-0.91), specificity: 1.0 (95% CI 0.99-1.0), PLR: 62.1 (95% CI 24.5-157.6), NLR: 0.33 (95% CI 0.16-0.69), and DOR: 300.25 (95% CI 85.01-1060.5)] were comparable. Heterogeneity was moderate. GeneXpert was frequently used among NAA tests, and its diagnostic accuracy was in line with the overall pooled summary estimates. The heterogeneity in diagnostic efficacy (0.05) could not be explained by a meta-regression and subgroup analysis of the research design, sample condition, and patient selection technique.
Our study suggested that NAAT can be applied as the preferred prescreening test for the timely diagnosis of staphylococcal strains associated with BJI in osteoarticular samples for successful antimicrobial therapy.
及时检测致病病原体及其耐药性对于指导骨和关节感染（BJI）患者的靶向治疗至关重要。我们进行了一项系统评价和荟萃分析，以评估核酸扩增试验（NAAT）检测骨关节炎样本对有效葡萄球菌菌株鉴定和 BJI 患者适当靶向抗菌药物治疗的诊断价值。
从开始到 2021 年 7 月 24 日，我们在五个数据库（包括 PubMed、Embase、Scopus、Web of Science 和 Cochrane 图书馆）中搜索了相关文献。比较 NAAT 与骨关节炎标本微生物培养参考标准的诊断准确性的研究符合条件。使用双变量随机效应荟萃分析计算 NAAT 与微生物培养参考标准相比的敏感性、特异性、阳性似然比（PLR）、阴性似然比（NLR）和诊断比值比（DOR）的汇总值。
从 906 条引文，纳入了 11 项研究。11 项研究包括 13 个数据集（=1047）评估了 NAAT 对甲氧西林敏感金黄色葡萄球菌（MSSA）鉴定的准确性，而 7 项研究包括 9 个数据集（=727）评估了耐甲氧西林金黄色葡萄球菌（MRSA）鉴定的准确性。与微生物培养参考标准相比，MSSA 检测的汇总综合估计值[敏感性：0.89（95%置信区间 [CI] 0.84-0.93），特异性：0.99（95% CI 0.97-0.99），PLR：34.13（95% CI 20.54-56.73），NLR：0.19（95% CI 0.12-0.3）和 DOR：283.37（95% CI 129.49-620.1）]和 MRSA [敏感性：0.81（95% CI 0.67-0.91），特异性：1.0（95% CI 0.99-1.0），PLR：62.1（95% CI 24.5-157.6）， NLR：0.33（95% CI 0.16-0.69）和 DOR：300.25（95% CI 85.01-1060.5）]相似。异质性中等。NAAT 中经常使用 GeneXpert，其诊断准确性与总体汇总综合估计值一致。诊断疗效的异质性（0.05）不能通过元回归和研究设计、样本条件和患者选择技术的亚组分析来解释。
我们的研究表明，NAAT 可作为骨关节炎样本中与 BJI 相关葡萄球菌菌株及时诊断的首选预筛选试验，以实现成功的抗菌治疗。
