Wild-Type Gyrase A Genotype of Neisseria gonorrhoeae Predicts In Vitro Susceptibility to Ciprofloxacin: A Systematic Review of the Literature and Meta-Analysis.
Wild-Type Gyrase A Genotype of Neisseria gonorrhoeae Predicts In Vitro Susceptibility to Ciprofloxacin: A Systematic Review of the Literature and Meta-Analysis.
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DOI：
10.1097/olq.0000000000000591
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发表时间：
2017-05
影响因子：
3.1
通讯作者：
Klausner JD
中科院分区：
文献类型：
--
作者：
Allan-Blitz LT;Wang X;Klausner JD
耐多药淋病奈瑟菌感染已被宣布为对公共卫生的三大紧迫威胁之一。对抗耐药性的方法包括使用以前被认为无效的抗生素进行靶向治疗，通过快速分子检测来预测敏感性。先前的研究将淋病奈瑟菌的促旋酶A（gyrA）基因与体外对环丙沙星的耐药性相关联。我们对淋病奈瑟菌gyrA基因型结果与传统抗菌药物敏感性试验结果进行了比较的研究进行了系统回顾。我们确定了31项符合纳入标准的研究，其中确定了1996年至2016年间来自16个国家的gyrA基因突变的7个不同位点。然后对采用实时PCR和非实时PCR技术分层的研究进行荟萃分析，比较两种PCR方法的汇总受试者工作特征曲线（sROC）。在使用实时PCR的研究中，gyrA基因型结果预测淋球菌对环丙沙星敏感性的敏感性和特异性的汇总估计值分别为98.2%（95%CI 96.5%-99.1%）和98.6%（95%CI 97.0%-99.3%）。使用实时PCR技术的研究的sROC与使用非实时PCR技术的研究的sROC很好地分离，在置信区间中仅有轻微重叠，表明实时PCR技术是更准确的方法。GyrA基因型检测是对抗多重耐药淋球菌出现的新方法，并且是预测体外环丙沙星敏感性的敏感和特异性方法。
Multidrug-resistant Neisseria gonorrhoeae infections have been declared one of the top three urgent threats to public health. Approaches to combat resistance include targeted therapy with antibiotics previously thought to be ineffective, made possible by rapid molecular assays to predict susceptibility. Previous studies have associated the gyrase A (gyrA) gene of Neisseria gonorrhoeae with in vitro resistance to ciprofloxacin. We conducted a systematic review of studies comparing Neisseria gonorrhoeae gyrA genotype results with conventional antimicrobial susceptibility test results. We identified 31 studies meeting inclusion criteria, among which seven different loci for mutations in the gyrA gene were identified, from sixteen countries between the years of 1996 and 2016. We then performed a meta-analysis among those studies stratifying by use of real-time PCR or non-real-time PCR technique, and compared the summary receiver operating characteristic curves (sROC) between the two PCR methods. Among studies using real-time PCR the pooled estimate of sensitivity and specificity of gyrA genotype results for the prediction of Neisseria gonorrhoeae susceptibility to ciprofloxacin were 98.2% (95% CI 96.5%-99.1%) and 98.6% (95% CI 97.0%-99.3%), respectively. The sROCs for studies using real-time PCR techniques were well separated from those using non-real-time PCR techniques, with only slight overlap in the confidence intervals, suggesting that real-time PCR techniques were a more accurate approach. GyrA genotype testing is a novel approach to combating the emergence of multi drug-resistant Neisseria gonorrhoeae, and is a sensitive and specific method to predict in vitro ciprofloxacin susceptibility.