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Updated: Jan 29, 2026
A High-throughput Platform for the Screening of Salmonella spp./Shigella spp.
Published on: November 7, 2018
Diagnostic Accuracy of Multiplex NAAT/PCR and Culture Against Salmonella spp.: A Comparison of Meta-Analytical
Xanthoula Rousou1, Luis Furuya-Kanamori2, Eleftherios Meletis1
1Laboratory of Epidemiology, Applied Machine Learning and Biostatistics, Faculty of Public and One Health, School of Health Sciences, University of Thessaly, 43100 Karditsa, Greece.
Background:
Non-typhoidal (NT) Salmonella spp. constitutes a major cause of foodborne illness. Culture is the gold standard, but it is time consuming, whereas multiplex nucleic acid amplification tests (NAATs)/Polymerase Chain Reaction (PCR) offer faster detection with variable reported performance.
Objectives:
To compare the diagnostic accuracy of multiplex NAAT/PCR and culture for Salmonella spp. using various statistical models with or without a gold standard assumption.
Methods:
A systematic search (PubMed, Web of Science, Scopus; up to April 2024) identified 44 studies (55 comparisons). Diagnostic performance was evaluated using the frequentists bivariate model (BM) and Split Component Synthesis (SCS) and the Bayesian bivariate models (BBMs) and hierarchical summary ROC (BHSROC).
Results:
Across models, multiplex NAAT/PCR demonstrated high specificity (>98%) but model-dependent variability in sensitivity (85.5-94.8%), consistently substantial between study heterogeneity and threshold variation. The BM and BBM yielded a higher sensitivity estimate with narrower non-overlapping confidence intervals while SCS and BHSROC models, which are more robust to threshold differences, produced more conservative estimates with wider uncertainty. In Bayesian latent class analyses, culture remained highly accurate (Se: 97.17%, 95% CrI: 70.3-99.99; Sp: 96.06%, 95% CrI: 78.9-99.99), but with wide credible intervals indicating variation between studies, perhaps due to the different protocols used.
Conclusion:
Model choice affects inferred diagnostic accuracy, particularly when high heterogeneity is present. Both multiplex NAAT/PCR and culture showed high accuracy; hence, a combination of the two tests could optimise rapid diagnosis and treatment. Future research should include cost effectiveness and decision analysis to update the diagnostic algorithms.
Insights
Multiplex nucleic acid amplification tests (NAATs)/Polymerase Chain Reaction (PCR) and culture both accurately detect non-typhoidal Salmonella. Combining these diagnostic methods can improve rapid identification and treatment of foodborne illness.
Area of Science:
- Microbiology
- Infectious Diseases
- Diagnostic Accuracy Studies
Background:
- Non-typhoidal Salmonella (NT) is a significant cause of foodborne illness.
- Traditional culture methods are time-consuming, while multiplex nucleic acid amplification tests (NAATs)/Polymerase Chain Reaction (PCR) offer faster results with variable performance.
- Accurate and rapid diagnostics are crucial for managing foodborne outbreaks.
Purpose of the Study:
- To compare the diagnostic accuracy of multiplex NAAT/PCR versus culture for Salmonella detection.
- To evaluate various statistical models, including those with and without a gold standard assumption, for assessing diagnostic performance.
- To understand the impact of statistical model choice on accuracy estimates.
Main Methods:
- A systematic literature search identified 44 studies (55 comparisons) up to April 2024.
- Diagnostic performance was assessed using frequentist bivariate models (BM, SCS) and Bayesian bivariate models (BBMs, BHSROC).
- Bayesian latent class analyses were employed to evaluate culture's accuracy.
Main Results:
- Multiplex NAAT/PCR showed high specificity (>98%) but variable sensitivity (85.5-94.8%) across models, with significant heterogeneity.
- Frequentist and Bayesian bivariate models yielded higher sensitivity estimates than SCS and BHSROC models.
- Culture demonstrated high accuracy (Se: 97.17%, Sp: 96.06%) but with wide credible intervals, indicating inter-study variation.
Conclusions:
- Model selection influences the inferred diagnostic accuracy, especially with high heterogeneity.
- Both multiplex NAAT/PCR and culture are highly accurate diagnostic methods for Salmonella.
- Combining NAAT/PCR and culture may optimize rapid diagnosis and treatment; further research on cost-effectiveness is recommended.
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