Abstract
Background: Treatment of bloodstream staphylococcal infections (BSI) necessitates the prompt initiation of appropriate antimicrobial agents and the rapid de-escalation of excessive broad-spectrum coverage to reduce the risk of mortality. We, therefore, aimed to demonstrate the diagnostic accuracy of nucleic acid amplification tests (NAAT) for the identification of methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) in clinically suspected patients.Methods: Until November 23, 2020, databases including PubMed, Scopus, Embase, and Web of Science were scanned for eligible studies. A bivariate random-effects model was used for meta-analysis of the 33 included studies obtained from 1606 citations, and pooled summary estimates with 95% confidence intervals (CI) were generated.Results: Twenty-three studies (n = 8,547) assessed NAAT accuracy for MSSA detection, while three studies (n = 479) evaluated MRSA detection in adults. The pooled NAAT sensitivity and specificity for MRSA in adults was higher [sensitivity: 0.83 (95% CI 0.59–0.96), specificity: 0.99 (95% CI 0.98–1.0)] as compared to MSSA [sensitivity: 0.76 (95% CI 0.69–0.82), specificity: 0.98 (95% CI 0.98–0.99)]. Similarly, eight studies (n = 4,089) investigating MSSA in pediatric population reported higher NAAT accuracy [sensitivity: 0.89 (95% CI 0.76–0.96), specificity: 0.98 (95% CI 0.97–0.98)] compared to adults. Among NAA tests, SeptiFast (real-time PCR, commercial) was frequently applied, and its diagnostic accuracy corresponded well to the overall summary estimates. A meta-regression and subgroup analysis of study design, sample condition, and patient selection method could not explain the heterogeneity (P > 0.05) in the diagnostic efficiency.Conclusions: NAAT could be applied as the preferred initial tests for timely diagnosis and BSI management.
Highlights
Bloodstream staphylococcal infection (BSI) is an urgent medical issue due to its rising incidence, associated poor outcome and the emergence of high rates of secondary infections such as osteomyelitis, septic arthritis, infective endocarditis and septic metastases [1, 2]
Several multiplex molecular assays have been cleared by the Food and Drug Administration (FDA) that can identify a wide range of microorganisms concurrently with specific resistance genes in blood samples, and several of these assays have been rendered commercially accessible [68]
Our results revealed that nucleic acid amplification tests (NAAT) overall summary estimates for methicillin-resistant S. aureus (MRSA) detection [sensitivity: 0.83, specificity: 0.99, area under the curve (AUC): 0.98] were higher as compared to methicillin-susceptible S. aureus (MSSA) [sensitivity: 0.76, specificity: 0.98, AUC: 0.98] among adults
Summary
Bloodstream staphylococcal infection (BSI) is an urgent medical issue due to its rising incidence, associated poor outcome and the emergence of high rates of secondary infections such as osteomyelitis, septic arthritis, infective endocarditis and septic metastases [1, 2]. In developed countries, methicillin-resistant S. aureus (MRSA) has been observed in over 60% of all isolated S. aureus, and associated MRSA mortality rates have reportedly been higher than methicillin-susceptible S. aureus (MSSA) [7]. Rapid identification of the causative agents and detection of resistance markers in patients with BSI, such as the mecA gene, may provide clinically vital information to guide effective care on time, leading to improved patient outcomes. Treatment of bloodstream staphylococcal infections (BSI) necessitates the prompt initiation of appropriate antimicrobial agents and the rapid de-escalation of excessive broad-spectrum coverage to reduce the risk of mortality. We aimed to demonstrate the diagnostic accuracy of nucleic acid amplification tests (NAAT) for the identification of methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) in clinically suspected patients
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