AUTHOR=Ojha Suvash Chandra , Chen Ke , Yuan Yue , Ahmed Sarfraz , Malik Aijaz Ahmad , Nisha Mehru , Sheng Yun-Jian , Sun Changfeng , Wu Gang , Deng Cun-Liang 

TITLE=Clinical relevance of molecular testing methods in the diagnosis and guidance of therapy in patients with staphylococcal empyema: a systematic review and meta-analysis

JOURNAL=Frontiers in Cellular and Infection Microbiology

VOLUME=Volume 12 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2022.758833

DOI=10.3389/fcimb.2022.758833

ISSN=2235-2988

ABSTRACT=Background: Effective diagnostic tool for determining staphylococcal pleural infection are critical for its eradication. The purpose of this meta-analysis was to evaluate the clinical yield of nucleic acid amplification tests (NAAT) for effective staphylococcal strain identification, and guidance of appropriate anti-staphylococcal agents, and rapid de-escalation of excessive broad-spectrum coverage.
Methods: From inception to July 24, 2021, relevant records were retrieved from PubMed, Embase, Scopus, Web of Science, and the Cochrane Library. The quality of studies was determined using the QUADAS-2 tool. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and hierarchical summary receiver operating characteristic (HSROC) curve for NAAT's diagnostic performance were evaluated using a HSROC model.
Results: Eight studies (n = 424) evaluated NAAT accuracy for methicillin-sensitive Staphylococcus aureus (MSSA) identification, while four studies (n = 317) evaluated methicillin-resistant Staphylococcus aureus (MRSA) identification. The pooled NAAT summary estimates for detection of both MSSA [sensitivity: 0.35 (95% CI 0.19–0.55), specificity: 0.95 (95% CI 0.92–0.97), PLR: 7.92 (95% CI 4.98–12.59), NLR: 0.44 (95% CI 0.14–1.46), and DOR: 24.0 (95% CI 6.59–87.61)] and MRSA [sensitivity: 0.45 (95% CI 0.15–0.78), specificity: 0.93 (95% CI 0.89–0.95), PLR: 10.06 (95% CI 1.49–67.69), NLR: 0.69 (95% CI 0.41–1.15), and DOR: 27.18 (95% CI 2.97–248.6)] were comparable. PCR was frequently used among NAA tests, and its diagnostic accuracy coincided well with 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 diagnostic effectiveness.
Conclusions: Our study suggested that the diagnostic accuracy of NAA tests is currently inadequate to substitute culture as a principal screening test. NAAT could be used in conjunction with microbiological culture due to the advantage of faster results and in situations where culture tests are not doable.