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首页> 外文期刊>Frontiers in Public Health >Evaluation and Comparison of Multiple Test Methods, Including Real-time PCR, for Legionella Detection in Clinical Specimens
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Evaluation and Comparison of Multiple Test Methods, Including Real-time PCR, for Legionella Detection in Clinical Specimens

机译：评估和比较临床样本中军团菌检测的多种测试方法（包括实时PCR）

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Legionella is a Gram-negative bacterium that can cause Pontiac fever, a mild upper respiratory infection and Legionnaire’s disease, a more severe illness. We aimed to compare the performance of urine antigen, culture, and polymerase chain reaction (PCR) test methods and to determine if sputum is an acceptable alternative to the use of more invasive bronchoalveolar lavage (BAL). Data for this study included specimens tested for Legionella at Public Health Ontario Laboratories from 1st January, 2010 to 30th April, 2014, as part of routine clinical testing. We found sensitivity of urinary antigen test (UAT) compared to culture to be 87%, specificity 94.7%, positive predictive value (PPV) 63.8%, and negative predictive value (NPV) 98.5%. Sensitivity of UAT compared to PCR was 74.7%, specificity 98.3%, PPV 77.7%, and NPV 98.1%. Out of 146 patients who had a Legionella-positive result by PCR, only 66 (45.2%) also had a positive result by culture. Sensitivity for culture was the same using either sputum or BAL (13.6%); sensitivity for PCR was 10.3% for sputum and 12.8% for BAL. Both sputum and BAL yield similar results regardless testing methods (Fisher Exact p-values = 1.0, for each test). In summary, all test methods have inherent weaknesses in identifying Legionella; therefore, more than one testing method should be used. Obtaining a single specimen type from patients with pneumonia limits the ability to diagnose Legionella, particularly when urine is the specimen type submitted. Given ease of collection and similar sensitivity to BAL, clinicians are encouraged to submit sputum in addition to urine when BAL submission is not practical from patients being tested for Legionella.
机译：军团杆菌是一种革兰氏阴性细菌，可导致庞蒂亚克发烧，轻度上呼吸道感染以及军团病（更严重的疾病）。我们旨在比较尿液抗原，培养和聚合酶链反应（PCR）测试方法的性能，并确定痰液是否可以替代更具侵略性的支气管肺泡灌洗（BAL）。这项研究的数据包括2010年1月1日至2014年4月30日在安大略省公共卫生实验室测试的军团菌样本，作为常规临床测试的一部分。我们发现与培养相比，尿抗原测试（UAT）的敏感性为87％，特异性为94.7％，阳性预测值（PPV）为63.8％，阴性预测值（NPV）为98.5％。与PCR相比，UAT的敏感性为74.7％，特异性为98.3％，PPV为77.7％，NPV为98.1％。在通过PCR获得军团菌阳性结果的146位患者中，只有66位（45.2％）通过培养获得了阳性结果。使用痰液或BAL进行培养的敏感性相同（13.6％）; PCR对痰的敏感性为10.3％，对BAL为12.8％。无论采用哪种测试方法，痰液和BAL都能产生相似的结果（每次测试均使用Fisher精确p值= 1.0）。总而言之，所有测试方法在鉴定军团菌方面都存在固有的弱点。因此，应使用一种以上的测试方法。从肺炎患者中获取单一样本类型会限制诊断军团菌的能力，尤其是在尿液为样本类型的情况下。考虑到易于收集和对BAL的敏感性，在接受军团菌检测的患者不可行BAL提交的情况下，鼓励临床医生除尿外还提供痰液。

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