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首页> 外文期刊>Journal of Clinical Microbiology >Clinical Application of Real-Time PCR to Screening Critically Ill and Emergency-Care Surgical Patients for Methicillin-Resistant Staphylococcus aureus: a Quantitative Analytical Study
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Clinical Application of Real-Time PCR to Screening Critically Ill and Emergency-Care Surgical Patients for Methicillin-Resistant Staphylococcus aureus: a Quantitative Analytical Study

机译：实时PCR在筛查耐甲氧西林金黄色葡萄球菌的重症和急诊外科手术患者中的临床应用：一项定量分析研究

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The clinical utility of real-time PCR screening assays for methicillin (meticillin)-resistant Staphylococcus aureus (MRSA) colonization is constrained by the predictive values of their results: as MRSA prevalence falls, the assay's positive predictive value (PPV) drops, and a rising proportion of positive PCR assays will not be confirmed by culture. We provide a quantitative analysis of universal PCR screening of critical care and emergency surgical patients using the BD GeneOhm MRSA PCR system, involving 3,294 assays over six months. A total of 248 PCR assays (7.7%) were positive; however, 88 failed to be confirmed by culture, giving a PPV of 65%. Multivariate analysis was performed to compare PCR-positive culture-positive (P+C+) and PCR-positive culture-negative (P+C?) assays. P+C? results were positively associated with a history of methicillin-sensitive Staphylococcus aureus infection or colonization (odds ratio [OR], 3.15; 95% confidence interval [CI], 1.32 to 7.54) and high PCR thresholds of signal intensity, indicative of a low concentration of target DNA (OR, 1.19 per cycle; 95% CI, 1.11 to 1.26). P+C? results were negatively associated with a history of MRSA infection or colonization (OR, 0.19; 95% CI, 0.09 to 0.42) and male sex (OR, 0.40; 95% CI, 0.20 to 0.81). P+C+ patients were significantly more likely to have subsequent positive MRSA culture assays and microbiological evidence of clinical MRSA infection. The risk of subsequent MRSA infection in P+C? patients was not significantly different from that in case-matched PCR-negative controls. We conclude that, given the low PPV and poor correlation between a PCR-positive assay and the clinical outcome, it would be prudent to await culture confirmation before altering infection control measures on the basis of a positive PCR result.
机译：耐甲氧西林（美西林）的金黄色葡萄球菌（MRSA）定植的实时PCR筛选测定的临床实用性受到其结果的预测值的限制：随着MRSA流行率的下降，该测定的阳性预测值（PPV）下降，阳性PCR分析的比例将无法通过培养进行确认。我们提供了使用BD GeneOhm MRSA PCR系统对重症监护和急诊手术患者进行通用PCR筛查的定量分析，涉及六个月内的3,294次检测。总共248次PCR检测（7.7％）呈阳性;然而，有88例未通过文化证实，PPV为65％。进行多变量分析以比较PCR阳性培养物阳性（P + C +）和PCR阳性培养物阴性（P + C +）测定。 P + C？结果与甲氧西林敏感的金黄色葡萄球菌感染或定殖史（优势比[OR]，3.15; 95％置信区间[CI]，1.32至7.54）和信号的高PCR阈值呈正相关强度低，表明目标DNA浓度低（OR，每个周期1.19; 95％CI，1.11至1.26）。 P + C？结果与MRSA感染或定殖史（OR，0.19; 95％CI，0.09至0.42）和男性（OR，0.40; 95％CI，0.20至0.81）负相关。 P + C +患者的随后MRSA培养阳性结果和临床MRSA感染的微生物学证据明显更高。随后在P + C中感染MRSA的风险？与病例匹配的PCR阴性对照相比，患者无明显差异。我们得出的结论是，鉴于PPV低且PCR阳性测定与临床结果之间的相关性较差，在基于阳性PCR结果改变感染控制措施之前，应等待培养确认，这是谨慎的做法。

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