Real-time PCR for the diagnosis of invasive Haemophilus influenzaebacteraemia and meningitis in children: A diagnostic accuracy study ofover 2,000 samples
H. O. Brien, M. Nielsen, K. Meyler, N. Sullivan, R. Cunney, R. Drew
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引用次数: 1
Abstract
results in a paediatric patient cohort and to review discordant results. Methods: A retrospective audit of all blood and CSF samples from a tertiary referral paediatric hospital sent to the Irish Meningitis and Sepsis Reference Laboratory over a four-year period. All PCR tests performed for H. influenzae which had a contemporaneous culture performed were included in the analysis. Results: For the blood PCR test, there were 10 positive samples out of 1,367 samples tested. The sensitivity was shown to be 60% (95% CI 14.6–94.73%) and the specificity was 99% (95% CI 98–99.7%). For the CSF assay, the sensitivity was 100% (95% CI 15.8–100%) with a specificity of 99% (95% CI 99.2–99.9%) and there were 5 positive samples by PCR out of the 1,224 samples tested. Ten patients had positive PCR results, with a negative corresponding culture (blood=7, CSF=3). Three of the 10 cases were deemed to be primary H. influenzae infections, while seven were deemed to be likely co-infection (respiratory syncytial virus=2, Influenza=2, measles=1, rotavirus=1, Staphylococcus aureus pneumonia=1). Conclusions: The incidence of invasive H. influenzae disease was low in this population. The sensitivity and specificity of the assay in CSF was excellent, but the sensitivity of the assay in blood was lower at 60%. Most patients with discordant PCR/culture results had viral co-infections. A more rational approach to requesting PCR is required in paediatric patients.
结果在一个儿科患者队列和审查不一致的结果。方法:回顾性审计所有血液和脑脊液样本从三级转诊儿科医院发送到爱尔兰脑膜炎和败血症参考实验室四年期间。同时进行培养的流感嗜血杆菌的所有PCR检测均纳入分析。结果:在血液PCR检测中,1367个样本中有10个呈阳性。灵敏度为60% (95% CI 14.6-94.73%),特异性为99% (95% CI 98-99.7%)。脑脊液检测的敏感性为100% (95% CI 15.8-100%),特异性为99% (95% CI 99.2-99.9%),在1224份检测样本中有5份PCR阳性样本。PCR阳性10例,相应培养阴性(血7例,脑脊液3例)。10例中有3例被认为是原发性流感嗜血杆菌感染,7例被认为可能是合并感染(呼吸道合胞病毒=2,流感=2,麻疹=1,轮状病毒=1,金黄色葡萄球菌肺炎=1)。结论:该人群侵袭性流感嗜血杆菌发病率较低。该方法在脑脊液中的敏感性和特异性都很好,但在血液中的敏感性较低,为60%。PCR/培养结果不一致的患者多为病毒共感染。在儿科患者中,需要采取更合理的方法来请求聚合酶链反应。