Real-time polymerase chain reaction and culture in the diagnosis of invasive group B streptococcal disease in infants: a retrospective study
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Group B streptococcus (GBS) is a leading cause of invasive disease in infants. Accurate and rapid diagnosis is crucial to reduce morbidity and mortality. Real-time polymerase chain reaction (PCR) targeting the dltR gene was utilised for the direct detection of GBS DNA in blood and cerebrospinal fluid (CSF) from infants at an Irish maternity hospital. A retrospective review of laboratory and patient records during the period 2011–2013 was performed in order to evaluate PCR and culture for the diagnosis of invasive GBS disease. A total of 3570 blood and 189 CSF samples from 3510 infants had corresponding culture and PCR results. Culture and PCR exhibited concordance in 3526 GBS-negative samples and 13 (25 %) GBS-positive samples (n = 53). Six (11 %) and 34 (64 %) GBS-positive samples were positive only in culture or PCR, respectively. Culture and PCR identified more GBS-positive infants (n = 47) than PCR (n = 43) or culture (n = 16) alone. Using culture as the reference standard, the sensitivity, specificity, and positive and negative predictive values for PCR on blood samples were 71.4 %, 99.2 %, 25 % and 99.9 %, and for CSF samples, they were 60 %, 97.8 %, 42.9 % and 98.9 %, respectively. The sensitivity and positive predictive values were improved (blood: 84.6 % and 55 %; CSF: 77.8 % and 100 %, respectively) when maternal risk factors and other laboratory test results were considered. The findings in this study recommend the use of direct GBS real-time PCR for the diagnosis of GBS infection in infants with a clinical suspicion of invasive disease and as a complement to culture, but should be interpreted in the light of other laboratory and clinical findings.
KeywordsPolymerase Chain Reaction Polymerase Chain Reaction Result Polymerase Chain Reaction Test Rotunda Hospital Maternal Risk Factor
The authors would like to thank Dr. Kathryn Harris, Great Ormond Street Hospital for the discussion and for providing details of the sip assay in advance of its publication and Dr. Robert Mulhall, Temple Street Children’s University Hospital for the assistance with the R software. The authors would like to acknowledge the Staff of the Irish Meningococcal and Meningitis Reference Laboratory, Temple Street Children’s University Hospital and Department of Clinical Pathology, Rotunda Hospital, in particular Prof. Philip Mayne and Dr. Melanie Cotter, Department of Biochemistry/Endocrinology and Department of Haematology, Rotunda Hospital, respectively, for the provision of laboratory results.
Conflict of interest
The authors declare that they have no conflict of interest.
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