{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:04:05Z","timestamp":1792785845727,"version":"4.5.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T00:00:00Z","timestamp":1718064000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute for Health","award":["NIHR203308"],"award-info":[{"award-number":["NIHR203308"]}]},{"name":"Care Research Manchester Biomedical Research Centre","award":["NIHR203308"],"award-info":[{"award-number":["NIHR203308"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This meta-analysis examines the comparative diagnostic performance of polymerase chain reaction (PCR) for the diagnosis of Pneumocystis pneumonia (PCP) on different respiratory tract samples, in both human immunodeficiency virus (HIV) and non-HIV populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 55 articles met inclusion criteria, including 11 434 PCR assays on respiratory specimens from 7835 patients at risk of PCP. QUADAS-2 tool indicated low risk of bias across all studies. Using a bivariate and random-effects meta-regression analysis, the diagnostic performance of PCR against the European Organisation for Research and Treatment of Cancer\u2013Mycoses Study Group definition of proven PCP was examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Quantitative PCR (qPCR) on bronchoalveolar lavage fluid provided the highest pooled sensitivity of 98.7% (95% confidence interval [CI], 96.8%\u201399.5%), adequate specificity of 89.3% (95% CI, 84.4%\u201392.7%), negative likelihood ratio (LR\u2212) of 0.014, and positive likelihood ratio (LR+) of 9.19. qPCR on induced sputum provided similarly high sensitivity of 99.0% (95% CI, 94.4%\u201399.3%) but a reduced specificity of 81.5% (95% CI, 72.1%\u201388.3%), LR\u2212 of 0.024, and LR+ of 5.30. qPCR on upper respiratory tract samples provided lower sensitivity of 89.2% (95% CI, 71.0%\u201396.5%), high specificity of 90.5% (95% CI, 80.9%\u201395.5%), LR\u2212 of 0.120, and LR+ of 9.34. There was no significant difference in sensitivity and specificity of PCR according to HIV status of patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>On deeper respiratory tract specimens, PCR negativity can be used to confidently exclude PCP, but PCR positivity will likely require clinical interpretation to distinguish between colonization and active infection, partially dependent on the strength of the PCR signal (indicative of fungal burden), the specimen type, and patient population tested.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciae239","type":"journal-article","created":{"date-parts":[[2024,4,30]],"date-time":"2024-04-30T07:47:23Z","timestamp":1714463243000},"page":"161-168","source":"Crossref","is-referenced-by-count":47,"title":["Polymerase Chain Reaction on Respiratory Tract Specimens of Immunocompromised Patients to Diagnose\n                    <i>Pneumocystis<\/i>\n                    Pneumonia: A Systematic Review and Meta-analysis"],"prefix":"10.1093","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9896-8682","authenticated-orcid":false,"given":"Lottie","family":"Brown","sequence":"first","affiliation":[{"name":"Institute of Infection and Immunity, St George's University and St Georges University Hospitals NHS Foundation Trust , London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1071-6040","authenticated-orcid":false,"given":"Riina","family":"Rautemaa-Richardson","sequence":"additional","affiliation":[{"name":"Mycology Reference Centre Manchester and Department of Infectious Diseases, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust and Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7422-0554","authenticated-orcid":false,"given":"Carlo","family":"Mengoli","sequence":"additional","affiliation":[{"name":"Department of Infectious, Parasitic and Immune-Mediated Diseases, Instituto Superiore Di Sanita , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9726-3082","authenticated-orcid":false,"given":"Alexandre","family":"Alanio","sequence":"additional","affiliation":[{"name":"Unit\u00e9 de Mycologie Mol\u00e9culaire, Institut Pasteur , Paris , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0574-8670","authenticated-orcid":false,"given":"Rosemary A","family":"Barnes","sequence":"additional","affiliation":[{"name":"Department of Infection, Immunity and Biochemistry and School of Medicine, University of Cardiff , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6870-3800","authenticated-orcid":false,"given":"St\u00e9phane","family":"Bretagne","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9, Parasitology-Mycology Laboratory, H\u00f4pital Saint-Louis , APHP, Paris , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9983-6603","authenticated-orcid":false,"given":"Sharon C A","family":"Chen","sequence":"additional","affiliation":[{"name":"Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital , Westmead , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Cordonnier","sequence":"additional","affiliation":[{"name":"Haematology and Stem Cell Transplant Department, Henri Mondor Hospital, and University Paris-Est-Cr\u00e9teil , Cr\u00e9teil , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8521-335X","authenticated-orcid":false,"given":"J Peter","family":"Donnelly","sequence":"additional","affiliation":[{"name":"Fungal PCR Initiative, a working group of the International Society of Human and Animal Mycology , Verona , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3696-5843","authenticated-orcid":false,"given":"Werner J","family":"Heinz","sequence":"additional","affiliation":[{"name":"Med. 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