这项研究的主要目的是评估耐甲氧西林金黄色葡萄球菌(MRSA)鼻拭子在MRSA糖尿病足感染中的阴性预测值。从成立到2020年5月1日,搜索了MEDLINE和Cochrane图书馆。使用以下搜索字符串:(耐甲氧西林金黄色葡萄球菌或MRSA)和(鼻或鼻孔)和(糖尿病足或糖尿病足感染)。包括所有包含将MRSA鼻拭子阳性与糖尿病足感染的伤口培养物进行比较的数据并符合纳入标准的研究。在86项相关研究中,纳入6项研究,共8706名糖尿病患者。遵循诊断测试准确性审查的系统审查和荟萃分析指南扩展的首选报告项目。主要荟萃分析结果是MRSA鼻拭子对MRSA糖尿病足感染的阴性和阳性预测值。通过生成分层汇总接收器特征操作曲线来确定合并的特异性和合并的灵敏度。在双变量荟萃分析中,涉及6项研究,合并的敏感性和特异性分别为41.7%(95%置信区间=32.9,51)和94.1%(95%置信区间=89.5,96.8),分别。在低中度MRSA患病率水平(<15%),MRSA鼻拭子的阴性预测值>90%,阳性预测值<55%.这项荟萃分析表明,在糖尿病足感染患者中,在MRSA糖尿病足感染的低至中度患病率地区,鼻拭子MRSA筛查的阳性预测值较差,但阴性预测值极好.
The primary objective of this study was to assess the negative predictive value of methicillin-resistant Staphylococcus aureus (MRSA) nasal swabs in MRSA diabetic foot infections. MEDLINE and Cochrane Library were searched from inception to May 1, 2020. The following search string was used: (methicillin-resistant S. aureus OR MRSA) AND (nasal OR nares) AND (diabetic OR foot OR diabetic foot infections). All studies that contained data comparing MRSA nasal swab positivity to wound cultures from diabetic foot infections and met the inclusion criteria were included. Among the 86 relevant studies, 6 studies with 8706 diabetic patients were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline extension for Diagnostic Test Accuracy reviews was followed. The primary meta-analysis outcomes were the negative and positive predictive values of MRSA nasal swabs for MRSA diabetic foot infections. The pooled specificity and pooled sensitivity were determined by generating hierarchical summary receiver characteristic operating curves. In the bivariate meta-analysis, involving the 6 studies, pooled sensitivity and specificity was 41.7% (95% confidence interval = 32.9, 51) and 94.1% (95% confidence interval = 89.5, 96.8), respectively. In low-moderate MRSA prevalence levels (<15%), negative predictive value of MRSA nasal swab was >90% and positive predictive value was <55%. This meta-analysis suggests that in patients with diabetic foot infections, the nasal swab MRSA screen has a poor positive predictive value but an excellent negative predictive value in regions of low to moderate prevalence of MRSA diabetic foot infections.