Abstract：
BACKGROUND: Streptococcus pneumoniae is a leading cause of bacterial meningitis worldwide. Conventional microbiological assays take several days and require the use of various drugs for empirical treatment. Rapid antigen tests in cerebrospinal fluid (CSF) may be useful to triage pneumococcal meningitis immediately.
OBJECTIVE: To elucidate whether rapid antigen tests in CSF are useful in the triage of pneumococcal meningitis.
METHODS: Data sourcesCochrane CENTRAL, MEDLINE, EMBASE, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov databases were searched. Study eligibility criteriaAll types of cohort studies except multiple-group studies, where the sensitivity and specificity of rapid antigen tests in CSF compared with CSF culture can be extracted. ParticipantsPatients with suspected meningitis. TestsRapid antigen tests in CSF. Reference standardsOne or more of the following: blood culture, CSF culture, and polymerase chain reaction in CSF. Assessment of risk of biasThe methodological quality of the included studies was assessed using QUADAS-2. Methods of data synthesisWe used a random-effects bivariate model for the meta-analysis. We conducted a subgroup analysis by dividing studies into types of antigen tests, adults and children, low-income and high-income countries, and with or without exposure to antibiotics before lumbar puncture.
RESULTS: Forty-four studies involving 14 791 participants were included. Most studies had a moderate-to-low methodological quality. Summary sensitivity and specificity were 99.5% (95% confidence interval (CI), 92.4-100%) and 98.2% (95% CI, 96.9-98.9%), respectively. Positive predictive values and negative predictive values at the median prevalence (4.2%) in the included studies were 70.8% (95% CI, 56.6-79.9%) and 100% (95% CI, 99.7-100%), respectively. The diagnostic accuracy was consistent across the various subgroups, except for slightly reduced sensitivity in high-income countries.
CONCLUSIONS: Rapid antigen tests in CSF would be useful in triaging pneumococcal meningitis. Further studies are warranted to investigate the clinical benefit of ruling out pneumococcal meningitis based on the results of rapid antigen tests.
OBJECTIVE: To elucidate whether rapid antigen tests in CSF are useful in the triage of pneumococcal meningitis.
METHODS: Data sourcesCochrane CENTRAL, MEDLINE, EMBASE, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov databases were searched. Study eligibility criteriaAll types of cohort studies except multiple-group studies, where the sensitivity and specificity of rapid antigen tests in CSF compared with CSF culture can be extracted. ParticipantsPatients with suspected meningitis. TestsRapid antigen tests in CSF. Reference standardsOne or more of the following: blood culture, CSF culture, and polymerase chain reaction in CSF. Assessment of risk of biasThe methodological quality of the included studies was assessed using QUADAS-2. Methods of data synthesisWe used a random-effects bivariate model for the meta-analysis. We conducted a subgroup analysis by dividing studies into types of antigen tests, adults and children, low-income and high-income countries, and with or without exposure to antibiotics before lumbar puncture.
RESULTS: Forty-four studies involving 14 791 participants were included. Most studies had a moderate-to-low methodological quality. Summary sensitivity and specificity were 99.5% (95% confidence interval (CI), 92.4-100%) and 98.2% (95% CI, 96.9-98.9%), respectively. Positive predictive values and negative predictive values at the median prevalence (4.2%) in the included studies were 70.8% (95% CI, 56.6-79.9%) and 100% (95% CI, 99.7-100%), respectively. The diagnostic accuracy was consistent across the various subgroups, except for slightly reduced sensitivity in high-income countries.
CONCLUSIONS: Rapid antigen tests in CSF would be useful in triaging pneumococcal meningitis. Further studies are warranted to investigate the clinical benefit of ruling out pneumococcal meningitis based on the results of rapid antigen tests.
摘要：
背景：肺炎链球菌是全球细菌性脑膜炎的主要原因。常规的微生物学测定需要几天的时间，需要使用各种药物进行经验性治疗。脑脊液（CSF）中的快速抗原测试可能有助于立即分类肺炎球菌性脑膜炎。
目的：阐明脑脊液快速抗原检测对肺炎球菌性脑膜炎的分类是否有用。
方法：数据来源：CochraneCENTRAL,MEDLINE,EMBASE,ICTRP,搜索了ClinicalTrials.gov数据库。
方法：除多组研究外，所有类型的队列研究，与CSF培养物相比，可以提取CSF中快速抗原测试的敏感性和特异性。
方法：疑似脑膜炎患者。
方法：CSF快速抗原检测。
UNASSIGNED：以下一种或多种：血液培养，CSF培养，和CSF中的聚合酶链反应。偏倚风险评估：纳入研究的方法学质量采用QUADAS-2进行评估。
方法：数据综合：我们使用随机效应双变量模型进行荟萃分析。我们通过将研究分为抗原测试类型进行了亚组分析，成人和儿童,低收入和高收入国家，以及腰椎穿刺前是否接触抗生素。
结果：纳入了44项研究，涉及14,791名参与者。大多数研究具有中等至低的方法学质量。汇总敏感性和特异性为99.5%(95%CI[置信区间]，92.4%-100%)和98.2%(95%CI，96.9%-98.9%)，分别。纳入研究的中位患病率（4.2％）的阳性预测值和阴性预测值分别为70.8％（95％CI，56.6％-79.9％）和100％（95％CI，99.7％-100％），分别。不同亚组的诊断准确性是一致的，除了高收入国家的敏感度略低。
结论：脑脊液中的快速抗原检测对肺炎球菌性脑膜炎的分类是有用的。有必要进行进一步的研究，以根据快速抗原测试的结果排除肺炎球菌性脑膜炎的临床益处。
目的：阐明脑脊液快速抗原检测对肺炎球菌性脑膜炎的分类是否有用。
方法：数据来源：CochraneCENTRAL,MEDLINE,EMBASE,ICTRP,搜索了ClinicalTrials.gov数据库。
方法：除多组研究外，所有类型的队列研究，与CSF培养物相比，可以提取CSF中快速抗原测试的敏感性和特异性。
方法：疑似脑膜炎患者。
方法：CSF快速抗原检测。
UNASSIGNED：以下一种或多种：血液培养，CSF培养，和CSF中的聚合酶链反应。偏倚风险评估：纳入研究的方法学质量采用QUADAS-2进行评估。
方法：数据综合：我们使用随机效应双变量模型进行荟萃分析。我们通过将研究分为抗原测试类型进行了亚组分析，成人和儿童,低收入和高收入国家，以及腰椎穿刺前是否接触抗生素。
结果：纳入了44项研究，涉及14,791名参与者。大多数研究具有中等至低的方法学质量。汇总敏感性和特异性为99.5%(95%CI[置信区间]，92.4%-100%)和98.2%(95%CI，96.9%-98.9%)，分别。纳入研究的中位患病率（4.2％）的阳性预测值和阴性预测值分别为70.8％（95％CI，56.6％-79.9％）和100％（95％CI，99.7％-100％），分别。不同亚组的诊断准确性是一致的，除了高收入国家的敏感度略低。
结论：脑脊液中的快速抗原检测对肺炎球菌性脑膜炎的分类是有用的。有必要进行进一步的研究，以根据快速抗原测试的结果排除肺炎球菌性脑膜炎的临床益处。
