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Table 4 Sensitivity and specificity estimates for diagnosis of S. pneumoniae, N. meningitidis, or H. influenzae meningitis

From: Accuracy of real-time PCR, Gram stain and culture for Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae meningitis diagnosis

 

Culture Standard

CRSa

LCA Modelb

Sens (%, 95CI)

Spec (%, 95CI)

Sens (%, 95CI)

Spec (%, 95CI)

Sens (%, 95CI)

Spec (%, 95CI)

S. pneumoniae, N. meningitidis, or H. influenzae

    

All patients, n=451

Culture

na

na

na

na

81.3 (73.2-89.3)

99.7 (99.1-100.0)

  

Gram stain

97.5 (91.3-99.7)

94.1 (91.2-96.3)

na

na

98.2 (95.2-100.0)

98.7 (97.3-100.0)

  

RT-PCR

95.0 (87.7-98.6)

90.0 (86.5-92.9)

91.2 (83.9-95.9)

94.3 (91.3-96.5)

95.7 (91.2-100.0)

94.3 (91.9-96.8)

Antibiotic negative, n=341

Culture

na

na

na

na

85.7 (74.4-96.9)

100.0 (99.8-100.0)

  

Gram stain

100.0 (89.7-100.0)

97.4 (94.9-98.9)

na

na

98.7 (94.9-100.0)

99.0 (97.9-100.0)

  

RT-PCR

97.1 (84.7-99.9)

96.1 (93.3-98.0)

90.5 (77.4-97.3)

97.7 (95.2-99.1)

95.8 (89.1-100.0)

97.7 (95.9-99.4)

Antibiotic positive, n=98

Culture

na

na

na

na

78.2 (66.4-89.9)

97.1 (91.9-100.0)

  

Gram stain

97.7 (88.0-99.9)

74.1 (60.4-85.0)

na

na

99.5 (97.3-100.0)

94.0 (84.1-100.0)

  

RT-PCR

93.2 (81.3-98.6)

55.6 (41.4-69.1)

91.4 (81.0-97.1)

70.0 (53.5-83.4)

95.3 (89.0-100.0)

70.2 (56.2-84.2)

S. pneumoniae only

      

All patients, n=451

Culture

na

na

na

na

85.3 (74.8-95.9)

100.0 (99.9-100.0)

  

Gram stain

97.5 (86.8-99.9)

97.6 (95.6-98.8)

na

na

96.4 (90.6-100.0)

99.0 (98.1-100.0)

  

RT-PCR

97.5 (86.8-99.9)

97.1 (95.0-98.5)

90.0 (78.2-96.7)

98.5 (96.8-99.5)

96.4 (90.6-100.0)

98.6 (97.4-99.7)

N. meningitidis only

      

All patients, n=451

Culture

na

na

na

na

77.9 (65.4-90.4)

99.8 (99.3-100.0)

  

Gram stain

97.2 (85.5-99.9)

97.4 (95.3-98.7)

na

na

98.7 (94.8-100.0)

99.6 (98.9-100.0)

  

RT-PCR

94.4 (81.3-99.3)

94.5 (91.8-96.5)

91.5 (79.6-97.6)

96.5 (94.3-98.1)

95.9 (89.3-100.0)

96.6 (94.8-98.3)

  1. Performance parameters for the various tests are estimated using a CSF culture reference standard, composite reference standard (CRS), and latent class analysis (LCA) modeling with stratification by antimicrobial detection disk bioassay results.
  2. Abbreviations: CRS, composite reference standard; LCA, latent class analysis; na, not applicable; 95% CI, 95% exact binomial confidence interval for culture reference standard and CRS parameters, or parameter estimate +/− 1.96 * standard error for LCA models.
  3. aComposite reference standard defined as positive if CSF culture or Gram stain positive for S. pneumoniae, N. meningitidis, or H. influenzae.
  4. bFor LCA model of all patients, disease prevalence was 21.5% (95% CI 17.7-25.4). For the model of antibiotic assay-negative patients, disease prevalence was 11.6% (95CI 8.2-15.0). For the model of antibiotic assay-positive patients, disease prevalence was 55.8% (96CI 45.4-66.1). For the model of S. pneumoniae diagnosis, disease prevelance was 10.4% (95CI 7.5-13.2). For the model of N. meningitidis diagnosis, disease prevalence was 10.0% (95CI 7.2-12.7). Bootstrap p for all models >0.1.