Department of General Internal Medicine, Asahi General Hospital, Asahi, Japan.
Department of Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Motomachi, Naka-ku, Hiroshima City, Hiroshima, Japan; Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan.
Clin Microbiol Infect. 2023 Mar;29(3):310-319. doi: 10.1016/j.cmi.2022.12.002. Epub 2022 Dec 8.
Streptococcus pneumoniae is a leading cause of bacterial meningitis worldwide. Conventional microbiological assays take several days and require the use of various drugs for empirical treatment. Rapid antigen tests in cerebrospinal fluid (CSF) may be useful to triage pneumococcal meningitis immediately.
To elucidate whether rapid antigen tests in CSF are useful in the triage of pneumococcal meningitis.
Data sourcesCochrane CENTRAL, MEDLINE, EMBASE, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov databases were searched. Study eligibility criteriaAll types of cohort studies except multiple-group studies, where the sensitivity and specificity of rapid antigen tests in CSF compared with CSF culture can be extracted. ParticipantsPatients with suspected meningitis. TestsRapid antigen tests in CSF. Reference standardsOne or more of the following: blood culture, CSF culture, and polymerase chain reaction in CSF. Assessment of risk of biasThe methodological quality of the included studies was assessed using QUADAS-2. Methods of data synthesisWe used a random-effects bivariate model for the meta-analysis. We conducted a subgroup analysis by dividing studies into types of antigen tests, adults and children, low-income and high-income countries, and with or without exposure to antibiotics before lumbar puncture.
Forty-four studies involving 14 791 participants were included. Most studies had a moderate-to-low methodological quality. Summary sensitivity and specificity were 99.5% (95% confidence interval (CI), 92.4-100%) and 98.2% (95% CI, 96.9-98.9%), respectively. Positive predictive values and negative predictive values at the median prevalence (4.2%) in the included studies were 70.8% (95% CI, 56.6-79.9%) and 100% (95% CI, 99.7-100%), respectively. The diagnostic accuracy was consistent across the various subgroups, except for slightly reduced sensitivity in high-income countries.
Rapid antigen tests in CSF would be useful in triaging pneumococcal meningitis. Further studies are warranted to investigate the clinical benefit of ruling out pneumococcal meningitis based on the results of rapid antigen tests.
肺炎链球菌是全球细菌性脑膜炎的主要病因。传统的微生物学检测需要数天时间，并且需要使用多种药物进行经验性治疗。脑脊液（CSF）中的快速抗原检测可能有助于立即对肺炎球菌性脑膜炎进行分诊。
阐明 CSF 中的快速抗原检测在肺炎球菌性脑膜炎的分诊中的作用。
资料来源 Cochrane 中心电子数据库、MEDLINE、EMBASE、世界卫生组织国际临床试验注册平台和 ClinicalTrials.gov 数据库均被检索。研究入选标准所有类型的队列研究，不包括多组研究，其中可以提取 CSF 中快速抗原检测与 CSF 培养相比的敏感性和特异性。参与者疑似脑膜炎患者。检测方法 CSF 中的快速抗原检测。参考标准一项或多项以下标准：血培养、CSF 培养和 CSF 中的聚合酶链反应。偏倚风险评估使用 QUADAS-2 对纳入研究的方法学质量进行评估。数据综合方法我们使用随机效应二变量模型进行荟萃分析。我们通过将研究分为抗原检测类型、成人和儿童、低收入和高收入国家以及腰椎穿刺前是否接触抗生素进行亚组分析。
纳入了 44 项涉及 14791 名参与者的研究。大多数研究的方法学质量为中低水平。汇总敏感性和特异性分别为 99.5%（95%置信区间，92.4-100%）和 98.2%（95%置信区间，96.9-98.9%）。在纳入研究的中位数（4.2%）患病率下，阳性预测值和阴性预测值分别为 70.8%（95%置信区间，56.6-79.9%）和 100%（95%置信区间，99.7-100%）。诊断准确性在各个亚组中是一致的，除了在高收入国家中敏感性略有降低。
CSF 中的快速抗原检测有助于对肺炎球菌性脑膜炎进行分诊。需要进一步研究以调查基于快速抗原检测结果排除肺炎球菌性脑膜炎的临床获益。
