Failure of Routine Diagnostic Methods to Detect Influenza in Hospitalized Older Adults
Failure of Routine Diagnostic Methods to Detect Influenza in Hospitalized Older Adults
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DOI：
10.1086/653202
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发表时间：
2010-07-01
影响因子：
4.5
通讯作者：
Edwards, Kathryn M.
中科院分区：
文献类型：
--
作者：
Talbot, H. Keipp;Williams, John V.;Edwards, Kathryn M.
目标。目的：明确使用常规诊断方法在老年住院成年人中检测流感的效用。设计：描述性研究。在2006-2007年和2007-2008年流感季节期间，一家学术医院和一家社区医院。伙伴。50岁或以上的住院成年人。方法：50岁或以上且有呼吸道疾病症状的住院成年人，通过逆转录聚合酶链式反应(RT-PCR)进行流感检测。以RT-PCR为金标准，我们评估了快速抗原检测和常规流感培养的性能，以及临床流感样疾病定义的诊断应用。结果：在我们研究的228例患者中，有26例(11%)用RT-PCR检测到流感。研究人员床边快速抗原检测的敏感性为19.2%(95%可信区间，8.51%-37.9%)，常规流感培养的敏感性为34.6%(95%可信区间，19.4%-53.8%)。快速抗原检测和培养检测流感的能力与病毒载量较高的患者有关(分别为P=0.002和P=.001)。结论：由于快速抗原检测和病毒培养的敏感性较低(分别为19.2%和34.6%)，这两种检测方法都不足以确定在医院实施哪种类型的隔离程序。《传染病控制与流行病学》2010；31(7)：683-688
OBJECTIVE. To define the utility of using routine diagnostic methods to detect influenza in older, hospitalized adults.DESIGN. Descriptive study.SETTING. One academic hospital and 1 community hospital during the 2006-2007 and 2007-2008 influenza seasons.PARTICIPANTS. Hospitalized adults 50 years of age or older.METHODS. Adults who were 50 years of age or older and hospitalized with symptoms of respiratory illness were enrolled and tested for influenza by use of reverse-transcriptase polymerase chain reaction (RT-PCR). Using RT-PCR as the gold standard, we assessed the performances of rapid antigen tests and conventional influenza culture and the diagnostic use of the clinical definition of influenza-like illness.RESULTS. Influenza was detected by use of RT-PCR in 26 (11%) of 228 patients enrolled in our study. The sensitivity of the rapid antigen test performed at bedside by research staff members was 19.2% (95% confidence interval, 8.51%-37.9%); the sensitivity of conventional influenza culture was 34.6% (95% confidence interval, 19.4%-53.8%). The ability to detect influenza with both the rapid antigen test and culture was associated with patients with a higher viral load (P = .002 and P = .001, respectively). The ability to diagnose influenza by use of the clinical definition of influenza-like illness had a higher sensitivity (80.8%) but lacked specificity (40.6%).CONCLUSION. Because rapid antigen testing and viral culture have poor sensitivity (19.2% and 34.6%, respectively), neither testing method is sufficient to use to determine what type of isolation procedures to implement in a hospital setting. Infect Control Hosp Epidemiol 2010; 31(7):683-688