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The diagnosis of mucormycosis by PCR in patients at risk: a systematic review and meta-analysis

Lottie Brown, L. Tschiderer, Alexandre Alanio, Rosemary A. Barnes, S. Chen, Massimo Cogliati, Mario Cruciani, J. Donnelly et al.

EClinicalMedicine, 2025

4,266 participants · 41 citations

Abstract

Summary Background This systematic review and meta-analysis aimed to examine the performance of polymerase chain reaction (PCR) assays for diagnosing mucormycosis. Methods A standardised search was conducted from conception to December 3rd 2024 using PubMed, Embase, Global Health, and Cochrane library. Original studies that used PCR-based methods on any human specimen to diagnose mucormycosis were analysed for eligibility. Using a bivariate meta-analysis, the diagnostic performance of PCR was examined against the European Organisation for Research and Treatment of Cancer–Mycoses Study Group Education and Research Consortium 2020 (EORTC-MSGERC) definitions of proven and probable invasive mould disease, which was modified to include all patients at risk of mucormycosis. The study protocol was registered on the PROSPERO database (CRD42023478667). Findings Of 4855 articles, a total of 30 met inclusion criteria, including 5920 PCR reactions on 5147 non-duplicate specimens from 819 cases of proven/probable mucormycosis and 4266 patients who did not meet the EORTC-MSGERC 2020 criteria. According to specimen type, sensitivity of PCR varied (p < 0.001) whereas specificity was similar (p = 0.662). Bronchoalveolar lavage fluid offered the highest sensitivity of 97.5% (95% CI 83.7–99.7%), specificity of 95.8% (95% CI 89.6–98.4%), positive likelihood ratio (LR+) of 23.5, and negative likelihood ratio (LR−) of 0.03. Tissue provided sensitivity of 86.4% (95% CI 78.9–91.5%), specificity of…

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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 4,266 participants or records.

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