Comparison of culture, confocal microscopy and PCR in routine hospital use for microbial keratitis diagnosis,Eye

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Comparison of culture, confocal microscopy and PCR in routine hospital use for microbial keratitis diagnosis
Eye ( IF 2.8 ) Pub Date : 2021-11-05 , DOI: 10.1038/s41433-021-01812-7
Jeremy J Hoffman _{1,

2,

3} , John K G Dart _{1,

3} , Surjo K De _{1,

4} , Nicole Carnt ₁ , Georgia Cleary ₁ , Scott Hau ₁

Affiliation

Aims

To evaluate the sensitivity and specificity of polymerase chain reaction (PCR), in vivo confocal microscopy (IVCM) and culture for microbial keratitis (MK) diagnosis.

Methods

Retrospective review of PCR, IVCM and culture results for MK diagnosis at Moorfields Eye Hospital between August 2013 and December 2014.

Results

PCR results were available for 259 MK patients with concurrent culture for 203/259 and IVCM for 149/259. Sensitivities and specificities with 95% confidence intervals [95% CI] were calculated for Acanthamoeba keratitis (AK) and fungal keratitis (FK), by comparison with culture, for both IVCM and PCR. For AK, FK and bacterial keratitis (BK) sensitivities were calculated, for each diagnostic method, by comparison with a composite reference standard (a positive result for one or more of culture, PCR or IVCM having a specificity of 100% by definition). For the latter, sensitivities with [95% CI] were: for AK, IVCM 77.1% [62.7–88.0%], PCR 63.3% [48.3–76.6%], culture 35.6 [21.9–51.2]; for FK, IVCM 81.8% [48.2–97.7%], PCR 30.8% [9.09–61.4%], culture 41.7% [15.2–72.3%]; for BK, PCR 25.0% [14.7–37.9%], culture 95.6% [87.6–99.1%].

Conclusion

IVCM was the most sensitive technique for AK and FK diagnosis but culture remains our gold standard for BK. These findings reflect results to be expected from service providers to UK ophthalmology units and demonstrates the need at our centre for ongoing diagnostic result audit leading to the potential to improve PCR diagnosis. Both FK and AK are now common in the UK; ophthalmology units need to have all these techniques available to optimise their MK management.

中文翻译：

培养、共聚焦显微镜和PCR在医院常规诊断微生物性角膜炎中的比较

目标

评估聚合酶链反应（PCR）、体内共聚焦显微镜（IVCM）和培养对微生物性角膜炎（MK）诊断的敏感性和特异性。

方法

对 2013 年 8 月至 2014 年 12 月期间在 Moorfields 眼科医院进行 MK 诊断的 PCR、IVCM 和培养结果进行回顾性审查。

结果

259 名 MK 患者获得了 PCR 结果，同时进行了 203/259 次培养和 149/259 次 IVCM 培养。通过与培养物比较，IVCM 和 PCR 计算棘阿米巴角膜炎 (AK) 和真菌性角膜炎 (FK) 的敏感性和特异性（95% 置信区间 [95% CI]）。对于每种诊断方法，通过与复合参考标准（培养、PCR 或 IVCM 中的一种或多种的阳性结果，根据定义具有 100% 的特异性）进行比较，计算 AK、FK 和细菌性角膜炎 (BK) 的敏感性。对于后者，敏感性 [95% CI] 为：AK、IVCM 77.1% [62.7–88.0%]、PCR 63.3% [48.3–76.6%]、培养 35.6 [21.9–51.2]；对于 FK，IVCM 81.8% [48.2–97.7%]，PCR 30.8% [9.09–61.4%]，培养 41.7% [15.2–72.3%]；对于 BK，PCR 25.0% [14.7–37.9%]，培养 95.6% [87.6–99.1%]。