AUTHOR=Chen Ke , Malik Aijaz Ahmad , Sheng Yun-Jian , Ahmed Sarfraz , Sun Changfeng , Deng Cun-Liang , Ojha Suvash Chandra 

TITLE=Clinical Utility of Molecular Tests for Guiding Therapeutic Decisions in Bloodstream Staphylococcal Infections: A Meta-Analysis

JOURNAL=Frontiers in Pediatrics

VOLUME=9

YEAR=2021

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2021.713447

DOI=10.3389/fped.2021.713447

ISSN=2296-2360

ABSTRACT=<p><bold>Background:</bold> 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 <italic>S. aureus</italic> (MRSA) and methicillin-sensitive <italic>S. aureus</italic> (MSSA) in clinically suspected patients.</p><p><bold>Methods:</bold> 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.</p><p><bold>Results:</bold> Twenty-three studies (<italic>n</italic> = 8,547) assessed NAAT accuracy for MSSA detection, while three studies (<italic>n</italic> = 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 (<italic>n</italic> = 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, Septi<italic>F</italic>ast (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 (<italic>P</italic> &gt; 0.05) in the diagnostic efficiency.</p><p><bold>Conclusions:</bold> NAAT could be applied as the preferred initial tests for timely diagnosis and BSI management.</p>