Multiplex PCR System for Rapid Detection of Pathogens in Patients with Presumed Sepsis - A Systemic Review and Meta-Analysis

Shy Shin Chang, Wen Han Hsieh, Ting Shou Liu, Si Huei Lee, Chih Hung Wang, Hao Chang Chou, Yee Hui Yeo, Ching Ping Tseng, Chien Chang Lee

Research output: Contribution to journalArticle

142 Citations (Scopus)

Abstract

Background:Blood culture is viewed as the golden standard for the diagnosis of sepsis but suffers from low sensitivity and long turnaround time. LightCycler SeptiFast (LC-SF) is a real-time multiplex polymerase chain reaction test able to detect 25 common pathogens responsible for bloodstream infections within hours. We aim to assess the accuracy of LC-SF by systematically reviewing the published studies.Method:Related literature on Medline, Embase, and Cochrane databases was searched up to October 2012 for studies utilizing LC-SF to diagnose suspected sepsis and that provided sufficient data to construct two-by-two tables.Results:A total of 34 studies enrolling 6012 patients of suspected sepsis were included. The overall sensitivity and specificity for LC-SF to detect bacteremia or fungemia was 0·75 (95% CI: 0·65-0·83) and 0·92 (95%CI:0·90-0·95), respectively. LC-SF had a high positive likelihood ratio (10·10) and a moderate negative likelihood ratio (0·27). Specifically, LC-SF had a sensitivity of 0·80 (95%CI: 0·70-0·88) and a specificity of 0·95(95%CI: 0·93-0·97) for the bacteremia outcome, and a sensitivity of 0·61 (95%CI: 0·48-0·72) and a specificity of 0·99 (95%CI: 0·99-0·99) for the fungemia outcome. High heterogeneity was found in the bacteremia outcome subgroup but not in the fungemia outcome subgroup.Conclusion:LC-SF is of high rule-in value for early detection of septic patients. In a population with low pretest probability, LC-SF test can still provide valuable information for ruling out bacteremia or fungemia.

Original languageEnglish
Article numbere62323
JournalPLoS One
Volume8
Issue number5
DOIs
Publication statusPublished - May 29 2013
Externally publishedYes

Fingerprint

microbial detection
Fungemia
bacteremia
Multiplex Polymerase Chain Reaction
Pathogens
Bacteremia
meta-analysis
sepsis (infection)
Meta-Analysis
Sepsis
Turnaround time
Polymerase chain reaction
Blood
blood flow
Real-Time Polymerase Chain Reaction
polymerase chain reaction
testing
Databases
Sensitivity and Specificity
fungemia

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Multiplex PCR System for Rapid Detection of Pathogens in Patients with Presumed Sepsis - A Systemic Review and Meta-Analysis. / Chang, Shy Shin; Hsieh, Wen Han; Liu, Ting Shou; Lee, Si Huei; Wang, Chih Hung; Chou, Hao Chang; Yeo, Yee Hui; Tseng, Ching Ping; Lee, Chien Chang.

In: PLoS One, Vol. 8, No. 5, e62323, 29.05.2013.

Research output: Contribution to journalArticle

Chang, Shy Shin ; Hsieh, Wen Han ; Liu, Ting Shou ; Lee, Si Huei ; Wang, Chih Hung ; Chou, Hao Chang ; Yeo, Yee Hui ; Tseng, Ching Ping ; Lee, Chien Chang. / Multiplex PCR System for Rapid Detection of Pathogens in Patients with Presumed Sepsis - A Systemic Review and Meta-Analysis. In: PLoS One. 2013 ; Vol. 8, No. 5.
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abstract = "Background:Blood culture is viewed as the golden standard for the diagnosis of sepsis but suffers from low sensitivity and long turnaround time. LightCycler SeptiFast (LC-SF) is a real-time multiplex polymerase chain reaction test able to detect 25 common pathogens responsible for bloodstream infections within hours. We aim to assess the accuracy of LC-SF by systematically reviewing the published studies.Method:Related literature on Medline, Embase, and Cochrane databases was searched up to October 2012 for studies utilizing LC-SF to diagnose suspected sepsis and that provided sufficient data to construct two-by-two tables.Results:A total of 34 studies enrolling 6012 patients of suspected sepsis were included. The overall sensitivity and specificity for LC-SF to detect bacteremia or fungemia was 0·75 (95{\%} CI: 0·65-0·83) and 0·92 (95{\%}CI:0·90-0·95), respectively. LC-SF had a high positive likelihood ratio (10·10) and a moderate negative likelihood ratio (0·27). Specifically, LC-SF had a sensitivity of 0·80 (95{\%}CI: 0·70-0·88) and a specificity of 0·95(95{\%}CI: 0·93-0·97) for the bacteremia outcome, and a sensitivity of 0·61 (95{\%}CI: 0·48-0·72) and a specificity of 0·99 (95{\%}CI: 0·99-0·99) for the fungemia outcome. High heterogeneity was found in the bacteremia outcome subgroup but not in the fungemia outcome subgroup.Conclusion:LC-SF is of high rule-in value for early detection of septic patients. In a population with low pretest probability, LC-SF test can still provide valuable information for ruling out bacteremia or fungemia.",
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AU - Chang, Shy Shin

AU - Hsieh, Wen Han

AU - Liu, Ting Shou

AU - Lee, Si Huei

AU - Wang, Chih Hung

AU - Chou, Hao Chang

AU - Yeo, Yee Hui

AU - Tseng, Ching Ping

AU - Lee, Chien Chang

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N2 - Background:Blood culture is viewed as the golden standard for the diagnosis of sepsis but suffers from low sensitivity and long turnaround time. LightCycler SeptiFast (LC-SF) is a real-time multiplex polymerase chain reaction test able to detect 25 common pathogens responsible for bloodstream infections within hours. We aim to assess the accuracy of LC-SF by systematically reviewing the published studies.Method:Related literature on Medline, Embase, and Cochrane databases was searched up to October 2012 for studies utilizing LC-SF to diagnose suspected sepsis and that provided sufficient data to construct two-by-two tables.Results:A total of 34 studies enrolling 6012 patients of suspected sepsis were included. The overall sensitivity and specificity for LC-SF to detect bacteremia or fungemia was 0·75 (95% CI: 0·65-0·83) and 0·92 (95%CI:0·90-0·95), respectively. LC-SF had a high positive likelihood ratio (10·10) and a moderate negative likelihood ratio (0·27). Specifically, LC-SF had a sensitivity of 0·80 (95%CI: 0·70-0·88) and a specificity of 0·95(95%CI: 0·93-0·97) for the bacteremia outcome, and a sensitivity of 0·61 (95%CI: 0·48-0·72) and a specificity of 0·99 (95%CI: 0·99-0·99) for the fungemia outcome. High heterogeneity was found in the bacteremia outcome subgroup but not in the fungemia outcome subgroup.Conclusion:LC-SF is of high rule-in value for early detection of septic patients. In a population with low pretest probability, LC-SF test can still provide valuable information for ruling out bacteremia or fungemia.

AB - Background:Blood culture is viewed as the golden standard for the diagnosis of sepsis but suffers from low sensitivity and long turnaround time. LightCycler SeptiFast (LC-SF) is a real-time multiplex polymerase chain reaction test able to detect 25 common pathogens responsible for bloodstream infections within hours. We aim to assess the accuracy of LC-SF by systematically reviewing the published studies.Method:Related literature on Medline, Embase, and Cochrane databases was searched up to October 2012 for studies utilizing LC-SF to diagnose suspected sepsis and that provided sufficient data to construct two-by-two tables.Results:A total of 34 studies enrolling 6012 patients of suspected sepsis were included. The overall sensitivity and specificity for LC-SF to detect bacteremia or fungemia was 0·75 (95% CI: 0·65-0·83) and 0·92 (95%CI:0·90-0·95), respectively. LC-SF had a high positive likelihood ratio (10·10) and a moderate negative likelihood ratio (0·27). Specifically, LC-SF had a sensitivity of 0·80 (95%CI: 0·70-0·88) and a specificity of 0·95(95%CI: 0·93-0·97) for the bacteremia outcome, and a sensitivity of 0·61 (95%CI: 0·48-0·72) and a specificity of 0·99 (95%CI: 0·99-0·99) for the fungemia outcome. High heterogeneity was found in the bacteremia outcome subgroup but not in the fungemia outcome subgroup.Conclusion:LC-SF is of high rule-in value for early detection of septic patients. In a population with low pretest probability, LC-SF test can still provide valuable information for ruling out bacteremia or fungemia.

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