Rapid and accurate identification of staphylococcal pneumonia is crucial for effective antimicrobial stewardship. We performed a meta-analysis to evaluate the diagnostic value of nucleic acid amplification tests (NAAT) from lower respiratory tract (LRT) samples of suspected pneumonia patients for avoiding superfluous empirical methicillin-resistant Staphylococcus aureus (MRSA) treatment. PubMed, Scopus, Embase, Web of Science, and the Cochrane library database were searched from inception to September 02, 2020. Data analysis was carried out using a bivariate random-effects model to estimate pooled sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR). Of 1808 citations, 24 publications comprising 32 datasets met our inclusion criteria. Twenty-two studies (n = 4630) assessed the accuracy of NAAT for methicillin-sensitive S. aureus (MSSA) detection, while ten studies (n = 2996) demonstrated the accuracy of NAAT for MRSA detection. The pooled NAAT sensitivity and specificity for all MSSA detection was higher [sensitivity: 0.91 (95% confidence interval [CI] 0.89–0.94), specificity: 0.94 (95% CI 0.94–0.95)] as compared to MRSA [sensitivity: 0.75 (95% CI 0.69–0.80), specificity: 0.88 (95% CI 0.86–0.89)] in lower respiratory tract (LRT) samples. NAAT pooled sensitivity differed marginally among differing LRT samples, including sputum, endotracheal aspirate (ETA), and bronchoalveolar lavage (BAL). Noticeably, NAAT pooled specificity against microbiological culture was consistently ≥88% across various types of LRT samples. A meta-regression and subgroup analysis of study design, sample condition, and patient selection method could not explain the heterogeneity (P >0.05) in the diagnostic efficiency. This meta-analysis has demonstrated that NAAT can be applied as the preferred initial test for timely diagnosis of staphylococcal pneumonia in LRT samples for successful antimicrobial therapy.

中文翻译：

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分子扩增测定法诊断葡萄球菌性肺炎的准确性：系统评价和荟萃分析

快速准确地识别葡萄球菌性肺炎对于有效的抗菌药物管理至关重要。我们进行了一项荟萃分析，以评估疑似肺炎患者下呼吸道 (LRT) 样本中核酸扩增试验 (NAAT) 的诊断价值，以避免多余的经验性耐甲氧西林金黄色葡萄球菌(MRSA) 治疗。PubMed、Scopus、Embase、Web of Science 和 Cochrane 图书馆数据库从开始到 2020 年 9 月 2 日进行了搜索。使用双变量随机效应模型进行数据分析，以估计汇总的敏感性、特异性、阳性似然比 (PLR)和负似然比 (NLR)。在 1808 篇引用中，包含 32 个数据集的 24 篇出版物符合我们的纳入标准。二十二项研究（n= 4630) 评估了 NAAT 对甲氧西林敏感的金黄色葡萄球菌(MSSA) 检测的准确性，而 10 项研究 ( n= 2996) 证明了 NAAT 检测 MRSA 的准确性。与 MRSA 相比，所有 MSSA 检测的汇总 NAAT 敏感性和特异性更高 [敏感性：0.91（95% 置信区间 [CI] 0.89-0.94），特异性：0.94（95% CI 0.94-0.95）] [敏感性：0.75（ 95% CI 0.69–0.80)，特异性：0.88 (95% CI 0.86–0.89)] 在下呼吸道 (LRT) 样本中。不同 LRT 样本（包括痰液、气管内吸出物 (ETA) 和支气管肺泡灌洗液 (BAL)）之间的 NAAT 汇总敏感性略有不同。值得注意的是，在各种类型的 LRT 样本中，NAAT 对微生物培养的综合特异性始终≥88%。研究设计、样本条件和患者选择方法的元回归和亚组分析无法解释异质性（P>0.05) 的诊断效率。该荟萃分析表明，NAAT 可用作及时诊断 LRT 样本中葡萄球菌性肺炎的首选初始检测，以实现成功的抗菌治疗。