Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2015 Oct 12;11(5):927-36.
doi: 10.5114/aoms.2015.54846.

Diagnostic accuracy of loop-mediated isothermal amplification in detection of Clostridium difficile in stool samples: a meta-analysis

Chen Wei  1 , Liu Wen-En  1 , Li Yang-Ming  1 , Luo Shan  1 , Zhong Yi-Ming  1
Affiliations
Review

Diagnostic accuracy of loop-mediated isothermal amplification in detection of Clostridium difficile in stool samples: a meta-analysis

Chen Wei et al. Arch Med Sci. .

Abstract

Introduction: Clostridium difficile infection (CDI) remains a diagnostic challenge for clinicians. More recently, loop-mediated isothermal amplification (LAMP) has become readily available for the diagnosis of CDI, and many studies have investigated the usefulness of LAMP for rapid and accurate diagnosis of CDI. However, the overall diagnostic accuracy of LAMP for CDI remains unclear. In this meta-analysis, our aim was to establish the overall diagnostic accuracy of LAMP in detection of Clostridium difficile (CD) in stool samples.

Material and methods: A search was done in PubMed, MEDLINE, EMBASE and Cochrane Library databases up to February 2014 to identify published studies that evaluated the diagnostic role of LAMP for CD. Methodological quality was assessed according to the quality assessment for studies of diagnostic accuracy (QUADAS) instrument. The sensitivities (SEN), specificities (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) were pooled statistically using random effects models. Statistical analysis was performed by employing Meta-Disc 1.4 software. Summary receiver operating characteristic (SROC) curves were used to summarize overall test performance. Funnel plots were used to test the potential publication bias.

Result: A total of 9 studies met inclusion criteria for the present meta-analysis. The pooled SEN and SPE for diagnosing CD were 0.93 (95% CI: 0.91-0.95) and 0.98 (95% CI: 0.98-0.99), respectively. The PLR was 47.72 (95% CI: 15.10-150.82), NLR was 0.07 (95% CI: 0.04-0.14) and DOR was 745.19 (95% CI: 229.30-2421.72). The area under the ROC was 0.98. Meta-regression indicated that the total number of samples was a source of heterogeneity for LAMP in detection of CD. The funnel plots suggested no publication bias.

Conclusions: The LAMP meets the minimum desirable characteristics of a diagnostic test of SEN, SPE and other measures of accuracy in the diagnosis of CD, and it is suitable as a rapid, effective and reliable stand-alone diagnostic test for diagnosis of CDI, potentially decreasing morbidity and nosocomial spread of CD.

Keywords: Clostridium difficile; loop-mediated isothermal amplification; meta-analysis.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram of study selection process
Figure 2
Figure 2
Forest plot of sensitivity for LAMP in the detection of Clostridium difficile. The point estimates of sensitivity from each study are shown as solid circles. Error bars indicate 95% confidence intervals
Figure 3
Figure 3
Forest plot of specificity for LAMP in the detection of Clostridium difficile. The point estimates of specificity from each study are shown as solid circles. Error bars indicate 95% confidence intervals
Figure 4
Figure 4
Forest plot of PLR for LAMP in the detection of Clostridium difficile. The point estimates of PLR from each study are shown as solid circles. Error bars indicate 95% confidence intervals
Figure 5
Figure 5
Forest plot of NLR for LAMP in the detection of Clostridium difficile. The point estimates of NLR from each study are shown as solid circles. Error bars indicate 95% confidence intervals
Figure 6
Figure 6
Forest plot of DOR for LAMP in the detection of Clostridium difficile. The point estimates of DOR from each study are shown as solid circles. Error bars indicate 95% confidence intervals
Figure 7
Figure 7
The SROC curve for LAMP in the detection of Clostridium difficile
Figure 8
Figure 8
The funnel plot for publication bias
See this image and copyright information in PMC

References

    1. Cohen SH, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) Infect Control Hosp Epidemiol. 2010;31:431–55. - PubMed
    1. Kelly CP. Current strategies for management of initial Clostridium difficile infection. J Hosp Med. 2012;7:S5–10. - PubMed
    1. Karas JA, Enoch DA, Aliyu SH. A review of mortality due to Clostridium difficile infection. J Infect. 2010;61:1–8. - PubMed
    1. Jank T, Giesemann T, Aktories K. Rho-glucosylating Clostridium difficile toxins A and B: new insights into structure and function. Glycobiology. 2010;17:15–22. - PubMed
    1. Goncalves C, Decre D, Barbut F, et al. Prevalence and characterization of a binary toxin (actin-specific ADP-ribosyltransferase) from Clostridium difficile. J Clin Microbiol. 2004;42:1933–9. - PMC - PubMed