4μg/mL万古霉素琼脂平板对万古霉素不敏感葡萄球菌筛查价值的Meta分析

Diagnostic Value of 4μg/mL vancomycin screening plate for vancomycin-nonsusceptible Staphylococcus aureus:a Meta-analysis

目的评价4μg/mL万古霉素平板筛查万古霉素不敏感葡萄球菌的准确性和特异性。方法计算机检索The Cochrane Library(2013年第2期)、PubMed(1996年至2013年8月)、ISI Web of Knowledge(1980年至2013年8月)、中文期刊全文数据库(1964年至2013年8月)、中文科技期刊数据库(1989年至2013年8月)、万方数据库(1998年至2013年8月),并用辅助手工检索,2名评价员严格根据纳入排除标准收集4μg/mL万古霉素平板筛查万古霉素不敏感葡萄球菌的试验。依据诊断性研究的质量评价(QUADAS)标准评价纳入文献的质量后,用Meta-Disc 1.4软件进行Meta分析。结果最后纳入3项研究,974例受试者。Meta分析结果显示:万古霉素平板筛查万古霉素不敏感金黄色葡萄球菌合并敏感性、特异性、阳性似然比、阴性似然比和诊断比值分别为0.805[95%CI(0.047,0.563)]、0.921[95%CI(0.901,0.938)]、10.804[95%CI(5.511,21.181)]、0.162[95%CI(0.71,1.0)]和69.721[95%CI(11.740,414.06)]。结论 4μg/mL万古霉素平板筛查万古霉素不敏感菌具有高特异性和高敏感性,可用于万古霉素不敏感菌的筛查。

Objective To evaluate the diagnostic accuracy of 4 μg/mL vancomycin screening plate （4VA）for vancomycin-non-susceptible Staphylococcus aureus.Methods The diagnosis trials on 4VA for vancomycin-non-susceptible Staphylococcus aureus were searched in the databases such as PubMed（1 966 to Aug.2013）,The Cochrane Library（the second phase of 2013）,ISI Web of Knowledge（1 980 to Aug.2013）,CNKI （1 964 to Aug.2013）,VIP （1 989 to Aug.2013）and Wanfang（1 998 to Aug.2013）,mean-while the manual.Two reviewers evaluated the quality of the included trials according to the quality assessment of diagnostic accu-racy studies,and then meta-analysis was performed using Meta-Disc 1.4 software.Results A total of 3 trials involving 974 partici-pants were included.The results of meta-analysis showed that the weighted sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio,were 0.805 [95%CI （0.047 to 0.563）],0.921 [95%CI （0.901 to 0.938）],10.804 [95%CI （5.5 1 1 to 21.181）],0.1 62 [95%CI （0.71 to 1.0）]and 69.721 [95%CI （1 1.740 to 414.06）]respectively.Conclusion 4VA for vancomycin-non-susceptible Staphylococcus aureus has a very high specificity and sensitivity,so 4VA could be used to creening plate （4VA）for vancomycin-non-susceptible Staphylococcus aureus in clinic.