Molecular Biology Department, Referencia Laboratorio Clínico, Santo Domingo Oeste, Santo Domingo, Dominican Republic.
Microbiology Department, Referencia Laboratorio Clínico, Santo Domingo Oeste, Santo Domingo, Dominican Republic.
Microbiol Spectr. 2024 Jun 4;12(6):e0005724. doi: 10.1128/spectrum.00057-24. Epub 2024 Apr 29.
[group B (GBS)] poses a major threat as the primary cause of early-onset neonatal invasive disease, particularly when mothers are colonized rectovaginally. Although culture remains the gold standard for antepartum GBS screening, quantitative polymerase chain reaction (qPCR) offers advantages in terms of sensitivity and turnaround time. The aim of this study was to validate the clinical utility of an automated qPCR laboratory-developed test (LDT) for antepartum GBS screening using the Panther Fusion Open Access system (Hologic, California, USA). The LDT targeted a conserved region of the GBS gene, demonstrating no cross-reactivity and high coverage (99.82%-99.99%). The limit of detection (LoD) was 118 CFU/mL. Comparison with commercial qPCR assays (Panther Fusion GBS and VIASURE B Real-Time) revealed an overall agreement of 99.7%, with a robust Cohen's kappa coefficient of 0.992. Testing of 285 rectovaginal swabs from pregnant women and 15 external quality assessment samples demonstrated exceptional diagnostic performance of the LDT, achieving a diagnostic sensitivity and specificity of 100%, underscoring its accuracy. Prevalence and predictive values were also determined to reinforce test reliability. Our research highlights the limitations of culture-based screening and supports the suitability of our qPCR-based LDT for GBS detection in a clinical setting.IMPORTANCERectovaginal colonization by GBS is a major risk factor for early-onset invasive neonatal disease. The most effective approach to reducing the incidence of early-onset disease (EOD) has been described as universal screening, involving assessment of GBS colonization status in late pregnancy and intrapartum antibiotic prophylaxis. Despite its turnaround time and sensitivity limitations, culture remains the gold standard method for GBS screening. However, nucleic acid amplification-based tests, such as qPCR, have been utilized due to their speed and high sensitivity and specificity. This study validated the clinical usefulness of an automated qPCR-LDT for antepartum GBS screening through the Panther Fusion Open Access system (Hologic). Our study addresses the critical need for more robust, sensitive, and rapid strategies for GBS screening in pregnant women that could favorably impact the incidence of EOD.
[B 组链球菌(GBS)]是导致新生儿早期侵袭性疾病的主要原因,尤其是当母亲直肠阴道定植时。虽然培养仍然是产前 GBS 筛查的金标准,但定量聚合酶链反应(qPCR)在灵敏度和周转时间方面具有优势。本研究旨在使用 Panther Fusion Open Access 系统(美国加利福尼亚州 Hologic)验证用于产前 GBS 筛查的自动化 qPCR 实验室开发检测(LDT)的临床实用性。LDT 针对 GBS 基因的保守区域,具有无交叉反应性和高覆盖率(99.82%-99.99%)。检测限(LoD)为 118 CFU/mL。与商业 qPCR 检测(Panther Fusion GBS 和 VIASURE B Real-Time)的比较显示总体一致性为 99.7%,稳健的 Cohen's kappa 系数为 0.992。对 285 例孕妇直肠阴道拭子和 15 例外部质量评估样本的检测显示,LDT 具有出色的诊断性能,诊断灵敏度和特异性均为 100%,强调了其准确性。还确定了患病率和预测值,以增强测试的可靠性。我们的研究强调了基于培养的筛查的局限性,并支持我们基于 qPCR 的 LDT 用于临床环境中的 GBS 检测。
重要性
直肠阴道定植的 GBS 是导致新生儿早期侵袭性疾病的主要危险因素。降低早期发病(EOD)发生率的最有效方法已被描述为普遍筛查,包括评估妊娠晚期和分娩时 GBS 定植状态和使用抗生素进行预防。尽管培养法的周转时间和灵敏度有限,但它仍然是 GBS 筛查的金标准方法。然而,由于其速度快、灵敏度和特异性高,核酸扩增检测,如 qPCR,已被用于该目的。本研究通过 Panther Fusion Open Access 系统(Hologic)验证了用于产前 GBS 筛查的自动化 qPCR-LDT 的临床实用性。我们的研究解决了孕妇 GBS 筛查更稳健、更敏感、更快速策略的迫切需求,这可能会有利地影响 EOD 的发病率。