背景:艰难梭菌感染的临床特征和预测因素与许多疾病重叠。
目的:我们进行了系统评价,以评估临床特征的诊断效用(临床检查,危险因素,实验室测试,影像学检查结果)与艰难梭菌相关。
方法:数据源:MEDLINE,EMBASE,CINAHL,和Cochrane数据库被搜索到2021年9月。
方法:报道艰难梭菌临床特征的研究,用于确认艰难梭菌诊断的有效参考标准测试,以及测试结果为阳性和阴性的患者之间的比较。
方法:不同临床环境的成人和儿童患者。
结果:灵敏度,特异性,似然比。
■粪便核酸扩增试验,酶免疫测定,细胞毒性试验,和粪便产毒培养。偏差风险评估:理性临床检查系列和QUADAS-2。数据综合方法:单变量和双变量分析。
结果:我们筛选了11,231篇文章,其中40篇被纳入,能够评估66个特征对艰难梭菌的诊断效用(10个临床检查结果,4个实验室测试,10个射线照相结果,以前接触过13种抗生素,和29个临床危险因素)。在临床检查中确定的十个特征中,在临床上没有与艰难梭菌感染可能性增加显著相关。一些增加艰难梭菌感染可能性的特征是粪便白细胞(LR+5.31,95%CI3.29-8.56)和前三个月入院(LR+2.14,95%CI1.48-3.11)。一些影像学检查结果也大大增加了艰难梭菌感染如腹水的可能性(LR+2.91,95%CI1.89-4.49)。
结论:仅床旁临床检查在检测艰难梭菌感染方面的作用有限。艰难梭菌感染的准确诊断需要周到的临床评估,以解释所有疑似病例的微生物检测。
BACKGROUND: The clinical features and predictors of Clostridioides difficile infection overlap with many conditions.
OBJECTIVE: We performed a systematic review to evaluate the diagnostic utility of clinical features (clinical examination, risk factors, laboratory tests, and radiographic findings) associated with C. difficile.
METHODS: Systematic review and meta-analysis of diagnostic features for C. difficile.
METHODS: MEDLINE, EMBASE, CINAHL, and Cochrane databases were searched up to September 2021.
METHODS: Studies that reported clinical features of C. difficile, a valid reference standard test for confirming diagnosis of C. difficile, and a comparison among patients with a positive and negative test result.
METHODS: Adult and paediatric patients across diverse clinical settings.
RESULTS: Sensitivity, specificity, likelihood ratios.
UNASSIGNED: Stool nucleic acid amplification tests, enzyme immunoassays, cell cytotoxicity assay, and stool toxigenic culture.
UNASSIGNED: Rational Clinical Examination Series and Quality Assessment of Diagnostic Accuracy Studies-2.
UNASSIGNED: Univariate and bivariate analyses.
RESULTS: We screened 11 231 articles of which 40 were included, enabling the evaluation of 66 features for their diagnostic utility for C. difficile (10 clinical examination findings, 4 laboratory tests, 10 radiographic findings, prior exposure to 13 antibiotic types, and 29 clinical risk factors). Of the ten features identified on clinical examination, none were significantly clinically associated with increased likelihood of C. difficile infection. Some features that increased likelihood of C. difficile infection were stool leukocytes (LR+ 5.31, 95% CI 3.29-8.56) and hospital admission in the prior 3 months (LR+ 2.14, 95% CI 1.48-3.11). Several radiographic findings also strongly increased the likelihood of C. difficile infection like ascites (LR+ 2.91, 95% CI 1.89-4.49).
CONCLUSIONS: There is limited utility of bedside clinical examination alone in detecting C. difficile infection. Accurate diagnosis of C. difficile infection requires thoughtful clinical assessment for interpretation of microbiologic testing in all suspected cases.