Validez de la reacción en cadena de la polimerasa para el diagnóstico de infecciones respiratorias producidas por Mycoplasma pneumoniae:meta-análisis
Palabras clave:
Meta-análisis, Mycoplasma pneumoniae, PCR, Infección, Sensibilidad y Especificidad.Resumen
Autores :Jesús Hernando Díaz1, Olga L. Sarmiento1, Claudia Liliana Satizábal1,
María del Pilar Delgado2 Carlos Alberto Jaramillo2, Santiago Ucrós3,
María Fernanda Mojica2, Oscar Andrés Martínez1,
Paula Natalia Rey2, Freddy Jean Karlo Toloza Bonilla1
1 Universidad de los Andes, Facultad de Medicina, Cra 1 No 18A-10, Edifi cio Q, Ofi cina-Q811, Bogotá, Colombia. MD (Drs. Díaz y
Martínez), MD, MPH, PhD (Dra. Sarmiento), PhD (Dra.Satizábal), estudiante de medicina (Sr.Toloza).
2 Universidad de los Andes, Facultad de Ciencias, Carrera 1 No. 18A–10, Edifi cio J, Laboratorio J203, Bogotá, Colombia. MSc (Sras.
Delgado y Mojica, Sr. Jaramillo), MPH (Sra. Rey).
3 Departamento de Pediatría, Fundación Santa Fe de Bogotá, Avenida 7 No 118-09, Bogotá, Colombia. MD, Esp Neumlogía pediátrica.
Introducción. Mycoplasma pneumoniae es considerado un frecuente agente etiológico de infecciones respiratorias y de una amplia gama de manifestaciones extra-pulmonares. Pruebas diagnósticas con baja exactitud y validez llevaron a considerar la reacción en cadena de la polimerasa (PCR) para el diagnóstico de M. pneumoniae. Objetivo: Evaluar la validez y la exactitud de la PCR para la detección de M. pneumoniae. Materiales y
Métodos: Meta-análisis de estudios que evaluaron el diagnóstico de M. pneumoniae en tracto respiratorio por PCR, publicados en MEDLINE desde noviembre de 1966 hasta julio de 2009. El análisis estadístico incluyó: i) cálculo de sensibilidad y especifi cidad de la PCR; ii) prueba de homogeneidad de estimadores entre estudios; iii) elaboración de summary receiver operating characteristic curves (SROC) por un modelo de regresión lineal; iv) método de Egger para evaluar sesgo de publicación.
Resultados: De 44 estudios incluidos los cuales incluyeron 6111 pacientes se calculó una sensibilidad de 0,72 (rango 0,21-0,99) y una especifi cidad de 0,96 (rango 0,06-0,99). Estudios en los cuales se incluyeron solo niños la PCR mostró menor exactitud. Estudios con concentraciones de cloruro de magnesio mayores de 1,5 mM mostraron mayor exactitud.
Conclusiones: Según los resultados de este estudio, la PCR no se recomienda como prueba rutinaria. Sin embargo, en casos con alta sospecha clínica de infección por M. pneumoniae en servicios de salud con alta prevalencia, la PCR es de utilidad. Estudios futuros deben reportar el espectro de la enfermedad y los resultados deben ser reportados por tipo de muestra y de acuerdo a los diferentes puntos de corte de la prueba de referencia utilizada.
Palabras clave: Meta-análisis, Mycoplasma pneumoniae, PCR, Infección, Sensibilidad y Especificidad.
POLIMERASE-CHAIN REACTION VALIDITY FOR DIAgNOSIS OF RESPIRATORY INFECTIONS CAUSED BY MYCOPLASMA PNEUMONIAE: META-ANALYSISABSTRACTIntroduction: Mycoplasma pneumoniae is considered an important cause of respiratory infections with a wide range of extra-pulmonary manifestations. Diffi culties in diagnosis of M.pneumoniae by culture and/or serology, have led to consider the Polymerase Chain Reaction (PCR) as a diagnostic test. Objective: To evaluate the validity and accuracy of PCR for detection of M. pneumoniae.
Materials and Methods: A meta-analysis was performed including molecular diagnostic studies of M. pneumonia in respiratory tract by PCR, published in the MEDLINE database from 1966 until June 2009. Statistical analysis included i)the calculation of sensitivity and specifi city for PCR, ii)Cochran homogeneity test (Q), iii)summary receiver operating characteristic (SROC) curves for a linear regression model and iv)Egger’s method for publication bias. Results: Forty-four studies including 6111 patients were included. Average sensitivity value was 0.72 and specifi city was 0.96 with ranges between 0.66 to 0.87 and 0.95 to 0.98, respectively. PCR was more accurate in studies including adults, compared to those including children only. Magnesium chloride concentration greater than 1.5mM showed better accuracy.
Conclusion: PCR is not recommended for routine clinical practice. However, it could be useful in highly suspicious cases of infection by M. pneumoniae in health settings with high prevalence. Future studies should report the spectrum of the disease, results by type of respiratory sample and results reported by cut points of the standard reference.
Keywords: Meta-Analysis, Mycoplasma pneumoniae, Polymerase Chain Reaction, Infection, Sensitivity and Specificity.
Biografía del autor/a
Olga Lucía Sarmiento, Facultad de Medicina, Universidad de los Andes, Bogotá
Jesús Hernando Díaz, Universidad de los Andes
Claudia Liliana Satizábal, Universidad de los Andes
María del Pilar Delgado, Universidad de los Andes
Carlos Alberto Jaramillo, Universidad de los Andes
Santiago Ucrós, Fundaciòn Santa Fé de Bogotá
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